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Prototype Prescribing Outlier Dashboard for NHS West Sussex 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 West Sussex CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Isradipine 1 Calcium-channel blockers 356,367 0.00 0.0 0.00 10.20
Triamcinolone acetonide 1 Topical corticosteroids 82,610 0.00 0.0 0.00 10.20
Tick-borne encephalitis vaccine 1 Vaccines and antisera 224,735 0.00 0.0 0.00 10.20
Galcanezumab 8 Prophylaxis of migraine 5,640 0.00 0.0 0.00 9.80
Ibrutinib 2 Other antineoplastic drugs 126 0.02 0.0 0.00 9.50
Benzoic acid 1 Antifungal preparations 12,094 0.00 0.0 0.00 8.95
Fluphenazine decanoate 14 Antipsychotic depot injections 181 0.08 0.0 0.01 8.76
Pristinamycin 8 Some other antibacterials 1,613 0.00 0.0 0.00 8.32
Granisetron hydrochloride 42 Drugs used in nausea and vertigo 48,629 0.00 0.0 0.00 6.62
Epoetin zeta 1 Hypoplastic/haemolytic and renal anaemias 11 0.09 0.0 0.01 6.13

Prescribing where NHS West Sussex CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydroxycarbamide 124 Other antineoplastic drugs 126 0.98 1.00 0.01 -2.50
Loperamide hydrochloride 14,192 Antimotility drugs 14,275 0.99 1.00 0.00 -1.68
Ropinirole hydrochloride 3,793 Dopaminergic drugs used in parkinsonism 37,394 0.10 0.16 0.04 -1.66
Nifedipine 5,604 Calcium-channel blockers 356,367 0.02 0.03 0.01 -1.60
Magnesium aspartate 225 Magnesium 846 0.27 0.53 0.17 -1.60
Estradiol with progestogen 17,594 Oestrogens and Hormone Replacement Therapy 57,097 0.31 0.38 0.05 -1.54
Oxybutynin 7,502 Drugs for urinary frequency enuresis and incontinence 63,712 0.12 0.18 0.04 -1.51
Co-trimoxazole(Trimethoprim/sulfamethoxazole) 961 Sulfonamides and trimethoprim 19,120 0.05 0.12 0.05 -1.42
Norethisterone 1,658 Progestogens and progesterone receptor modulators 14,601 0.11 0.27 0.11 -1.42
Medroxyprogesterone acetate 4,164 Parenteral progestogen-only contraceptives 5,228 0.80 0.89 0.06 -1.41