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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Benzydamine hydrochloride 47 Rubefacients, topical NSAIDS, capsaicin and poultice 21,881 0.00 0.00 0.00 7.67
Povidone iodine 8 Ocular diagnostic & peri-operative prepn & photodynamic tt 288 0.03 0.00 0.00 7.32
Potassium chloride 1 Electrolytes and water 380 0.00 0.00 0.00 6.05
Wool fat 1 Vehicles 1 1.00 0.06 0.19 5.05
Hydromorphone hydrochloride 215 Opioid analgesics 80,740 0.00 0.00 0.00 4.85
Acenocoumarol 338 Oral anticoagulants 51,894 0.01 0.00 0.00 4.83
Pioglitazone hydrochloride 9,925 Other antidiabetic drugs 54,637 0.18 0.04 0.03 4.50
Amoxicillin sodium 4 Broad-spectrum penicillins 21,003 0.00 0.00 0.00 4.42
Isopropyl alcohol 1 Alcohols and saline 1 1.00 0.09 0.21 4.34
Clonazepam 4 Drugs used in status epilepticus 302 0.01 0.00 0.00 4.01

Prescribing where NHS Salford CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cetomacrogol 0 Vehicles 1 0.00 0.89 0.23 -3.89
    Alfentanil hydrochloride 16 Opioid analgesics 56 0.29 0.91 0.20 -3.13
    Alcohol 0 Alcohols and saline 1 0.00 0.84 0.31 -2.70
      Hydralazine hydrochloride 258 Vasodilator antihypertensive drugs 410 0.63 0.86 0.09 -2.55
      Carbamazepine 6,221 Control of epilepsy 130,396 0.05 0.07 0.01 -2.09
      Glucose 538 Treatment of hypoglycaemia 807 0.67 0.78 0.06 -2.04
      Pizotifen malate 1,517 Prophylaxis of migraine 3,212 0.47 0.62 0.07 -2.04
      Zopiclone 10,268 Hypnotics 22,807 0.45 0.60 0.08 -2.00
      Furosemide 30,017 Loop diuretics 40,549 0.74 0.86 0.06 -1.95
      Nicorandil 3,863 Other antianginal drugs 14,380 0.27 0.50 0.12 -1.86