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Prototype Prescribing Outlier Dashboard for NHS East Riding Of Yorkshire 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 East Riding Of Yorkshire CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Flunisolide 4 Drugs used in nasal allergy 30,426 0.00 0.00 0.00 10.20
Finasteride 1 Shampoos and some other scalp preparations 4,916 0.00 0.00 0.00 9.04
Darunavir 1 HIV infection 1 1.00 0.02 0.12 8.45
Mometasone/glycopyrronium/indacaterol 108 Corticosteroids (respiratory) 82,502 0.00 0.00 0.00 7.36
Potassium chloride 3 Electrolytes and water 978 0.00 0.00 0.00 7.09
Guanfacine 322 CNS Stimulants and drugs used for ADHD 2,494 0.13 0.02 0.02 5.07
Cefradine 271 Cephalosporins 1,116 0.24 0.03 0.04 4.99
Nicotine bitartrate 17 Nicotine dependence 364 0.05 0.01 0.01 4.95
Carvedilol 12,173 Beta-adrenoceptor blocking drugs 190,545 0.06 0.01 0.01 4.82
Timolol 1,217 Beta-adrenoceptor blocking drugs 190,545 0.01 0.00 0.00 4.65

Prescribing where NHS East Riding Of Yorkshire CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cefalexin 801 Cephalosporins 1,116 0.72 0.96 0.05 -4.96
Fusidic acid 1,576 Antibacterial preparations also used systemically 2,745 0.57 0.74 0.06 -2.74
Furosemide 34,670 Loop diuretics 49,924 0.69 0.86 0.06 -2.68
Methylprednisolone acetate 780 Local corticosteroid injections 2,642 0.30 0.72 0.18 -2.34
Naproxen 33,447 Non-steroidal anti-inflammatory drugs 56,111 0.60 0.69 0.04 -2.19
Glycopyrronium bromide 0 Antimuscarinic drugs 4 0.00 0.74 0.34 -2.17
    Mirtazapine 27,527 Other antidepressant drugs 61,302 0.45 0.56 0.05 -2.09
    Neomycin sulfate 931 Nasal preparations for infection 1,269 0.73 0.84 0.05 -2.09
    Procyclidine hydrochloride 1,672 Antimuscarinic drugs used in parkinsonism 2,200 0.76 0.87 0.05 -2.08
    Salbutamol 80,730 Selective beta(2)-agonists 96,211 0.84 0.89 0.03 -2.07