Skip to main content

Prototype Prescribing Outlier Dashboard for NHS Halton 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 Halton CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Mianserin hydrochloride 21 Tricyclic and related antidepressant drugs 25,925 0.00 0.00 0.00 8.41
Other soothing haemorrhoidal preparations 19 Soothing haemorrhoidal preparations 328 0.06 0.01 0.01 6.52
Dexamethasone sodium phosphate 9 Use of corticosteroids 10,783 0.00 0.00 0.00 6.48
Hydrochlorothiazide 17 Thiazides and related diuretics 17,142 0.00 0.00 0.00 6.25
Clonazepam 2 Drugs used in status epilepticus 105 0.02 0.00 0.00 5.87
Triamterene with thiazides 8 Potassium sparing diuretics and compounds 439 0.02 0.00 0.00 4.93
Memantine hydrochloride 3,184 Drugs for dementia 3,846 0.83 0.41 0.09 4.57
Liraglutide 2,214 Other antidiabetic drugs 21,847 0.10 0.03 0.02 4.34
Artificial saliva 25 Treatment of dry mouth 34 0.74 0.21 0.12 4.31
Bethanechol chloride 7 Drugs for urinary retention 10,859 0.00 0.00 0.00 4.11

Prescribing where NHS Halton CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Donepezil hydrochloride 399 Drugs for dementia 3,846 0.10 0.46 0.08 -4.29
Glucose blood testing reagents 10,290 Diabetic diagnostic and monitoring agents 12,052 0.85 0.94 0.02 -4.16
Vitamin A 32 Vitamin A 177 0.18 0.83 0.18 -3.67
Ivermectin 84 Topical preparation for rosacea 132 0.64 0.87 0.07 -3.34
Pilocarpine hydrochloride 3 Treatment of dry mouth 34 0.09 0.56 0.17 -2.74
Ganciclovir 2 Antivirals 8 0.25 0.64 0.17 -2.32
Tacrolimus 167 Drugs affecting the immune response 267 0.63 0.80 0.08 -2.20
Ipratropium bromide 97 Topical nasal decongestants 1,073 0.09 0.36 0.13 -2.13
Methylphenidate hydrochloride 407 CNS Stimulants and drugs used for ADHD 813 0.50 0.66 0.08 -2.12
Insulin aspart 2,874 Short-acting insulins 4,706 0.61 0.78 0.08 -2.11