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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Monobasic potassium phosphate 2 Phosphate supplements 44 0.05 0.00 0.01 7.58
Cyproterone acetate 31 Male sex hormones and antagonists 18,302 0.00 0.00 0.00 6.09
Ethinylestradiol 4 Oestrogens and Hormone Replacement Therapy 7,941 0.00 0.00 0.00 5.97
Disopyramide phosphate 46 Drugs for arrhythmias 1,962 0.02 0.00 0.00 4.36
Other lozenge and spray preparations 1 Lozenges and sprays 9 0.11 0.00 0.03 4.23
Other non-opioid analgesic preparations 16 Non-opioid analgesics and compound preparations 160,790 0.00 0.00 0.00 4.20
Linagliptin/metformin 1,213 Other antidiabetic drugs 59,962 0.02 0.00 0.00 4.20
Botulinum toxin type A 4 Essential tremor,chorea,tics and related disorders 209 0.02 0.00 0.00 3.84
Zonisamide 2,106 Control of epilepsy 135,019 0.02 0.01 0.00 3.80
Testosterone 2,943 Male sex hormones and antagonists 18,302 0.16 0.07 0.03 3.73

Prescribing where NHS Barnsley CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other amino acidandnutritional agent preparations 53 Amino acids and nutritional agents 113 0.47 0.95 0.14 -3.40
Brinzolamide 821 Treatment of glaucoma 33,411 0.02 0.10 0.02 -3.13
Potassium citrate 38 Drugs used in urological pain 48 0.79 0.94 0.06 -2.56
Permethrin 287 Parasiticidal preparations 386 0.74 0.85 0.05 -2.20
Other food for special diet preparations 1,608 Foods for special diets 4,714 0.34 0.64 0.14 -2.12
Adapalene and benzoyl peroxide 251 Topical preparations for acne 4,203 0.06 0.16 0.05 -1.99
Beclometdiprop/formoterol/glycopyrronium 2,206 Selective beta(2)-agonists 100,554 0.02 0.07 0.03 -1.98
Ivermectin 55 Topical preparation for rosacea 75 0.73 0.87 0.07 -1.96
Lamotrigine 10,935 Control of epilepsy 135,019 0.08 0.11 0.01 -1.93
Emollient bath and shower preparations 1,929 Emollient bath and shower preparations 4,206 0.46 0.64 0.09 -1.90