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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Levobupivacaine hydrochloride 130 Local anaesthetics 20,482 0.01 0.00 0.00 10.20
Gripe mixtures 1 Sodium bicarbonate 56 0.02 0.00 0.00 8.34
Gluten free pastas 4 Foods for special diets 9,199 0.00 0.00 0.00 7.97
Epoetin zeta 2 Hypoplastic/haemolytic and renal anaemias 18 0.11 0.00 0.01 7.52
Flumetasone pivalate 333 Otitis externa 19,724 0.02 0.00 0.00 6.98
Gluten free/wheat free cereals 2 Foods for special diets 9,199 0.00 0.00 0.00 6.81
Levofloxacin 1,372 Quinolones 4,754 0.29 0.05 0.04 6.61
Liquefied phenol 1 Phenolics 3 0.33 0.01 0.06 5.83
Ruxolitinib 2 Other antineoplastic drugs 1,494 0.00 0.00 0.00 5.10
Ferrous gluconate 10,437 Oral iron 90,095 0.12 0.03 0.02 3.66

Prescribing where NHS Devon CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium bicarbonate 55 Sodium bicarbonate 56 0.98 1.00 0.00 -8.34
Ciprofloxacin 2,989 Quinolones 4,754 0.63 0.86 0.05 -4.22
Dexamethasone 13,061 Otitis externa 19,724 0.66 0.79 0.05 -2.71
Fexofenadine hydrochloride 33,711 Antihistamines 169,747 0.20 0.36 0.07 -2.33
Oral rehydration salts 1,942 Oral sodium and water 5,010 0.39 0.65 0.11 -2.27
Betamethasone esters 1,672 Topical corticosteroids 141,063 0.01 0.03 0.01 -2.20
Fusidic acid 359 Antibacterials 13,283 0.03 0.08 0.03 -2.12
Senna 39,769 Stimulant laxatives 110,838 0.36 0.55 0.10 -2.03
Ticagrelor 2,285 Antiplatelet drugs 467,104 0.00 0.02 0.01 -2.02
Lactulose 19,621 Osmotic laxatives 127,773 0.15 0.28 0.06 -1.89