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Prototype Prescribing Outlier Dashboard for NHS Shropshire, Telford And Wrekin 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 Shropshire, Telford And Wrekin CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Dextromethorphan hydrobrom compound prepartions 3 Expectorant and demulcent cough preparations 137 0.02 0.00 0.00 7.50
Paliperidone 150 Antipsychotic drugs 44,595 0.00 0.00 0.00 6.86
Gentamicin sulfate 3 Antibacterial preparations also used systemically 4,418 0.00 0.00 0.00 6.60
Erdosteine 658 Mucolytics 18,545 0.04 0.00 0.01 5.85
Iron carboxymaltose 1 Parenteral iron 1 1.00 0.04 0.17 5.74
Sodium clodronate 305 Bisphosphonates and other drugs 39,898 0.01 0.00 0.00 5.28
Betaine anhydrous 3 Drugs used in metabolic disorders 3 1.00 0.06 0.18 5.17
Dibrompropamidine isetionate 12 Preparations for minor cuts and abrasions 65 0.18 0.02 0.04 4.51
Tamsulosin and dutasteride hydrochloride 4,119 Drugs for urinary retention 50,880 0.08 0.02 0.01 4.34
Other alcohol and saline preparations 11 Alcohols and saline 13 0.85 0.04 0.19 4.30

Prescribing where NHS Shropshire, Telford And Wrekin CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Iron dextran 0 Parenteral iron 1 0.00 0.90 0.27 -3.30
    Alcohol 0 Alcohols and saline 13 0.00 0.84 0.31 -2.70
      Pseudoephedrine hydrochloride 48 Systemic nasal decongestants 57 0.84 0.97 0.05 -2.53
      Clotrimazole 3,199 Vaginal and vulval infections 3,806 0.84 0.91 0.03 -2.14
      Combined ethinylestradiol 35mcg 442 Combined hormonal contraceptives 14,360 0.03 0.06 0.01 -1.91
      Finasteride 14,414 Male sex hormones and antagonists 19,591 0.74 0.83 0.05 -1.87
      Alkyl sulphate 134 Cationic surfactants and soaps 135 0.99 1.00 0.00 -1.82
      Pilocarpine hydrochloride 101 Treatment of dry mouth 399 0.25 0.56 0.17 -1.79
      Ferrous fumarate 10,125 Oral iron 36,916 0.27 0.56 0.16 -1.77
      Allopurinol 29,596 Gout and cytotoxic induced hyperiuicaemia 33,732 0.88 0.91 0.02 -1.77