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Prototype Prescribing Outlier Dashboard for NHS East Staffordshire 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 Staffordshire CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pilocarpine nitrate 448 Treatment of glaucoma 24,113 0.02 0.00 0.00 8.65
Enalapril maleate with diuretic 214 Angiotensin-converting enzyme inhibitors 71,611 0.00 0.00 0.00 8.61
Haemophilus influenzae B/meningococcal C 9 Vaccines and antisera 27,523 0.00 0.00 0.00 8.08
Alverine citrate/simeticone 12 Antispasmodic and other drugs altering gut motility 8,303 0.00 0.00 0.00 5.56
Haloperidol 577 Antipsychotic drugs 5,414 0.11 0.03 0.01 5.22
Sodium fusidate 24 Some other antibacterials 230 0.10 0.01 0.02 4.99
Pilocarpine hydrochloride 396 Treatment of glaucoma 24,113 0.02 0.00 0.00 4.95
Other mouth wash, gargle and dentifrice preparations 8 Mouth-washes, gargles and dentifrices 162 0.05 0.01 0.01 4.54
Nifedipine 4,387 Calcium-channel blockers 67,815 0.06 0.03 0.01 4.37
Tolfenamic acid 35 Treatment of acute migraine 4,861 0.01 0.00 0.00 4.08

Prescribing where NHS East Staffordshire CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 144 Mouth-washes, gargles and dentifrices 162 0.89 0.98 0.02 -4.46
Methotrexate 1,393 Rheumatic disease suppressant drugs 4,569 0.30 0.59 0.09 -3.20
Medroxyprogesterone acetate 0 Progestogens 12 0.00 0.67 0.25 -2.62
    Estriol 368 Preparations for vaginal/vulval changes 3,563 0.10 0.42 0.12 -2.61
    Ivermectin 34 Topical preparation for rosacea 49 0.69 0.87 0.07 -2.52
    Filgrastim 0 Drugs used in neutropenia 9 0.00 0.84 0.36 -2.31
      Octreotide acetate 0 Somatostatin analogues 10 0.00 0.63 0.30 -2.06
        Clobetasone butyrate 1,413 Topical corticosteroids 16,403 0.09 0.13 0.02 -2.01
        Sevelamer 10 Phosphate binding agents 179 0.06 0.41 0.19 -1.86
        Ticagrelor 304 Antiplatelet drugs 50,813 0.01 0.02 0.01 -1.86