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Prototype Prescribing Outlier Dashboard for North Chelmsford NHS Hcc

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 Practices. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given Practice 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 Practice's chemical:subparagraph ratios is provided, with this Practice'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 North Chelmsford NHS Hcc is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pentosan polysulfate sodium 7 Oral anticoagulants 856 0.01 0.00 0.00 20.52
Doxylamine succinate/pyridoxine hydrochloride 13 Drugs used in nausea and vertigo 401 0.03 0.00 0.01 6.27
Brimonidine tartrate 70 Treatment of glaucoma 517 0.14 0.03 0.02 5.67
Miconazole nitrate 14 Vaginal and vulval infections 68 0.21 0.01 0.03 5.65
Calcium acetate/magnesium carbonate 4 Phosphate binding agents 4 1.00 0.05 0.18 5.35
Calcium carbonate 9 Compound Alginates and proprietary indigestion preparations 154 0.06 0.00 0.01 4.94
Dipipanone hydrochloride 2 Opioid analgesics 882 0.00 0.00 0.00 4.84
Selegiline hydrochloride 10 Dopaminergic drugs used in parkinsonism 143 0.07 0.00 0.01 4.68
Triptorelin acetate 13 Prostate cancer and gonadorelin analogues 52 0.25 0.02 0.06 3.88
Diclofenac sodium 7 Rubefacients, topical NSAIDS, capsaicin and poultice 178 0.04 0.00 0.01 3.75

Prescribing where North Chelmsford NHS Hcc is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Alginic acid compound preparations 145 Compound Alginates and proprietary indigestion preparations 154 0.94 1.00 0.01 -4.38
Clotrimazole 50 Vaginal and vulval infections 68 0.74 0.90 0.09 -1.95
Solifenacin 44 Drugs for urinary frequency enuresis and incontinence 340 0.13 0.33 0.11 -1.78
Clobetasol propionate 20 Topical corticosteroids 748 0.03 0.08 0.03 -1.78
Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 2 0.00 0.67 0.39 -1.73
    Mirtazapine 538 Other antidepressant drugs 1,391 0.39 0.57 0.10 -1.72
    Neomycin sulfate 26 Nasal preparations for infection 43 0.60 0.84 0.14 -1.69
    Olanzapine 57 Antipsychotic drugs 756 0.08 0.22 0.09 -1.66
    Isosorbide mononitrate 80 Nitrates 147 0.54 0.72 0.11 -1.65
    Latanoprost 90 Treatment of glaucoma 517 0.17 0.31 0.08 -1.63