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Prototype Prescribing Outlier Dashboard for NHS Greater Preston 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 Greater Preston CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Thioridazine 8 Antipsychotic drugs 24,334 0.00 0.00 0.00 7.38
Meningococcal A + C + W135 + Y vaccine 20 Vaccines and antisera 32,889 0.00 0.00 0.00 5.60
Levocetirizine 839 Antihistamines 25,251 0.03 0.01 0.01 5.31
Dihydrocodeine tartrate 15,727 Opioid analgesics 58,630 0.27 0.07 0.04 5.30
Fluphenazine hydrochloride 3 Antipsychotic drugs 24,334 0.00 0.00 0.00 5.25
Docusate sodium 18 Removal of ear wax and other substances 30 0.60 0.15 0.10 4.50
Other topical nasal decongestant preparations 3 Topical nasal decongestants 715 0.00 0.00 0.00 4.25
Ciclesonide 556 Corticosteroids (respiratory) 49,492 0.01 0.00 0.00 4.02
Hydrocortisone acetate 2 Local corticosteroid injections 1,241 0.00 0.00 0.00 4.02
Propafenone hydrochloride 202 Drugs for arrhythmias 3,036 0.07 0.02 0.01 4.01

Prescribing where NHS Greater Preston CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Urea hydrogen peroxide 12 Removal of ear wax and other substances 30 0.40 0.84 0.10 -4.26
Codeine phosphate 114 Cough suppressants 274 0.42 0.76 0.12 -2.97
Baclofen 2,233 Skeletal muscle relaxants 4,134 0.54 0.80 0.10 -2.68
Procyclidine hydrochloride 1,331 Antimuscarinic drugs used in parkinsonism 1,822 0.73 0.87 0.05 -2.64
Hydralazine hydrochloride 152 Vasodilator antihypertensive drugs 245 0.62 0.86 0.09 -2.64
Insulin aspart 2,802 Short-acting insulins 4,801 0.58 0.78 0.08 -2.43
Calcium carbonate 341 Calcium supplements 371 0.92 0.97 0.02 -2.26
Aluminium chloride 70 Antiperspirants 73 0.96 0.99 0.02 -2.18
Sodium cromoglicate 590 Other anti-inflammatory preparations 1,228 0.48 0.66 0.09 -2.12
Fluorouracil (Sunscreen) 32 Sunscreening preparations 465 0.07 0.45 0.18 -2.11