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Prototype Prescribing Outlier Dashboard for NHS Bedfordshire, Luton And Milton Keynes 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 Bedfordshire, Luton And Milton Keynes CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Obeticholic acid 1 Drugs affecting biliary composition and flow 3,108 0.00 0.00 0.00 10.20
Monobasic potassium phosphate 5 Phosphate supplements 131 0.04 0.00 0.01 6.34
Morphine tartrate and cyclizine tartrate 1 Opioid analgesics 168,509 0.00 0.00 0.00 5.60
Co-danthramer (Dantron/poloxamer 188) 93 Stimulant laxatives 48,925 0.00 0.00 0.00 5.43
Clofazimine 6 Antileprotic drugs 151 0.04 0.00 0.01 5.38
Other topical nasal decongestant preparations 13 Topical nasal decongestants 2,535 0.01 0.00 0.00 5.36
Ciclosporin 82 Tear deficiency, eye lubricant/astringent 21,159 0.00 0.00 0.00 4.49
Ciclosporin (Eye Anti Inflammatory) 2,314 Other anti-inflammatory preparations 10,882 0.21 0.06 0.03 4.47
Titanium dioxide 9 Sunscreening preparations 1,647 0.01 0.00 0.00 3.49
Methyl salicylate/levomenthol 14 Rubefacients, topical NSAIDS, capsaicin and poultice 42,289 0.00 0.00 0.00 3.06

Prescribing where NHS Bedfordshire, Luton And Milton Keynes CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dapsone 145 Antileprotic drugs 151 0.96 1.00 0.01 -5.38
Iodine compounds 9 Chlorine and iodine 16 0.56 0.95 0.14 -2.85
Carbocisteine 19,671 Mucolytics 25,703 0.77 0.96 0.08 -2.36
Other phosphate supplement preparations 124 Phosphate supplements 131 0.95 0.99 0.02 -2.26
Sodium cromoglicate 5,232 Other anti-inflammatory preparations 10,882 0.48 0.66 0.09 -2.12
Tetanus immunoglobulin 0 Disease-specific immunoglobulins 1 0.00 0.80 0.42 -1.90
    Ibuprofen 5,674 Non-steroidal anti-inflammatory drugs 96,880 0.06 0.11 0.03 -1.78
    Mometasone furoate 10,098 Drugs used in nasal allergy 57,886 0.17 0.33 0.09 -1.74
    Rivaroxaban 11,147 Oral anticoagulants 158,654 0.07 0.22 0.09 -1.66
    Alfentanil hydrochloride 21 Opioid analgesics 36 0.58 0.91 0.20 -1.64