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Prototype Prescribing Outlier Dashboard for NHS Oldham CCG

At OpenPrescribing we are piloting a number of data-driven approaches to identify unusual prescribing and collect feedback on this prescribing to inform development of new tools to support prescribers and organisations to audit and review prescribing. These pilot results are provided for the interest of advanced users, although we don't know how relevant they are in practice. There is substantial variation in prescribing behaviours, across various different areas of medicine. Some variation can be explained by demographic changes, or local policies or guidelines, but much of the remaining variation is less easy to explain.

The DataLab is keen to hear your feedback on the results. You can do this by completing the following survey or emailing us at [email protected]. Please DO NOT INCLUDE IDENTIFIABLE PATIENT information in your feedback. All feedback is helpful, you can send short or detailed feedback.

This report has been developed to automatically identify prescribing patterns at a chemical level which are furthest away from “typical prescribing” and can be classified as an “outlier”. We calculate the number of prescriptions for each chemical in the BNF coding system, the count of all prescriptions within that chemical's BNF subparagraph, for prescriptions dispensed between June 2021 and December 2021. We then calculate the ratio of these counts along with the mean and standard deviation of those ratios across all CCGs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given CCG is from the population mean. We then rank your “z-scores” to find the top 10 results where prescribing is an outlier for prescribing higher than its peers and those where it is an outlier for prescribing lower than its peers.

For each outlier chemical, a kernel density estimation plot of all CCG's chemical:subparagraph ratios is provided, with this CCG's ratio overlaid in red.

It is important to remember that this information was generated automatically and it is therefore likely that some of the behaviour is warranted. This report seeks only to collect information about where this variation may be warranted and where it might not, to inform research on this topic. Our full analytical method code is openly available on GitHub here.

This is a new, experimental feature. We'd love to .

Prescribing where NHS Oldham CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Compound antispasmodic preparations 8 Antispasmodic and other drugs altering gut motility 14,839 0.00 0.00 0.00 8.42
Xipamide 88 Thiazides and related diuretics 27,907 0.00 0.00 0.00 6.34
Famciclovir 57 Herpes simplex and varicella-zoster 1,998 0.03 0.01 0.00 5.79
Pyrazinamide 4 Antituberculosis drugs 78 0.05 0.00 0.01 5.74
Atenolol with calcium channel blocker 68 Beta-adrenoceptor blocking drugs 105,310 0.00 0.00 0.00 5.47
Benzbromarone 10 Gout and cytotoxic induced hyperiuicaemia 17,329 0.00 0.00 0.00 5.47
Nandrolone decanoate 1 Anabolic steroids 1 1.00 0.04 0.18 5.23
Sodium fusidate 56 Some other antibacterials 529 0.11 0.01 0.02 5.07
Buserelin 1 Drugs affecting gonadotrophins 1 1.00 0.06 0.20 4.79
Alimemazine tartrate 403 Antihistamines 49,777 0.01 0.00 0.00 4.73

Prescribing where NHS Oldham CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Prasterone 0 Anabolic steroids 1 0.00 0.95 0.19 -5.03
    Urea hydrogen peroxide 70 Removal of ear wax and other substances 136 0.51 0.84 0.10 -3.16
    Donepezil hydrochloride 2,523 Drugs for dementia 10,805 0.23 0.46 0.08 -2.71
    Folic acid 17,836 Drugs used in megaloblastic anaemias 49,769 0.36 0.67 0.12 -2.54
    Nicorandil 2,393 Other antianginal drugs 10,797 0.22 0.50 0.12 -2.24
    Finasteride 6,940 Male sex hormones and antagonists 9,668 0.72 0.83 0.05 -2.23
    Spironolactone 6,075 Potassium-sparing diuretics and aldosterone antagonists 11,364 0.53 0.71 0.08 -2.17
    Terbinafine hydrochloride 1,120 Other antifungals 1,141 0.98 0.99 0.01 -2.15
    Clotrimazole 1,285 Antifungal preparations 4,400 0.29 0.45 0.07 -2.08
    Alfentanil hydrochloride 1 Opioid analgesics 2 0.50 0.91 0.20 -2.06