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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dolutegravir/lamivudine 1 HIV infection 2 0.50 0.01 0.06 8.72
Other urological pain preparations 9 Drugs used in urological pain 41 0.22 0.01 0.02 8.67
Lumacaftor/ivacaftor 1 Mucolytics 9,991 0.00 0.00 0.00 8.66
Glucose 124 Foods for special diets 170 0.73 0.08 0.08 8.27
Etanercept 3 Rheumatic disease suppressant drugs 11,895 0.00 0.00 0.00 7.60
Pantoprazole 35,630 Proton pump inhibitors 260,578 0.14 0.02 0.02 5.75
Ibuprofen sodium dihydrate 6 Non-steroidal anti-inflammatory drugs 30,221 0.00 0.00 0.00 5.65
Nefopam hydrochloride 11,083 Non-opioid analgesics and compound preparations 142,949 0.08 0.01 0.01 5.32
Benzocaine 32 Drugs for oral ulceration and inflammation 2,049 0.02 0.00 0.00 4.63
Linagliptin/metformin 1,229 Other antidiabetic drugs 56,767 0.02 0.00 0.00 4.54

Prescribing where NHS Rotherham CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium citrate 22 Drugs used in urological pain 41 0.54 0.94 0.06 -6.86
Sodium cromoglicate 32 Cromoglycate and related therapy 36 0.89 0.99 0.03 -3.17
Other food for special diet preparations 46 Foods for special diets 170 0.27 0.64 0.14 -2.62
Finasteride 8,717 Male sex hormones and antagonists 12,463 0.70 0.83 0.05 -2.59
Morphine sulfate 9,288 Opioid analgesics 72,383 0.13 0.22 0.04 -2.53
Pilocarpine hydrochloride 23 Treatment of dry mouth 148 0.16 0.56 0.17 -2.35
Losartan potassium 10,825 Angiotensin-II receptor antagonists 67,557 0.16 0.48 0.14 -2.30
Senna 10,991 Stimulant laxatives 32,777 0.34 0.55 0.10 -2.28
Insulin glargine 1,427 Intermediate and long-acting insulins 16,031 0.09 0.32 0.10 -2.26
Ketoconazole 1,458 Shampoos and some other scalp preparations 4,184 0.35 0.48 0.06 -2.25