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Prototype Prescribing Outlier Dashboard for Greater Manchester Health & Social Care Partnership

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 STPs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given STP 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 STP's chemical:subparagraph ratios is provided, with this STP'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 Greater Manchester Health & Social Care Partnership is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tocilizumab 1 Rheumatic disease suppressant drugs 80,653 0.00 0.00 0.00 6.33
Chenodeoxycholic acid 8 Drugs affecting biliary composition and flow 10,035 0.00 0.00 0.00 6.33
Human papillomavirus (Type 16,18) 1 Vaccines and antisera 496,473 0.00 0.00 0.00 6.33
Carglumic acid 1 Drugs used in metabolic disorders 32 0.03 0.00 0.00 6.09
Promazine hydrochloride 48,587 Antipsychotic drugs 440,733 0.11 0.01 0.02 5.89
Glten free /wheat/free /low/protein cooking aids 5 Foods for special diets 48,606 0.00 0.00 0.00 5.05
Zafirlukast 15 Leukotriene receptor antagonists 134,788 0.00 0.00 0.00 4.83
Chloroquine phosphate 153 Antimalarials 86,996 0.00 0.00 0.00 4.57
Other otitis external preparations 24 Otitis externa 47,374 0.00 0.00 0.00 4.44
Povidone iodine 21 Ocular diagnostic & peri-operative prepn & photodynamic tt 2,936 0.01 0.00 0.00 4.17

Prescribing where Greater Manchester Health & Social Care Partnership is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Montelukast 134,773 Leukotriene receptor antagonists 134,788 1.00 1.00 0.00 -4.83
Carbamazepine 60,168 Control of epilepsy 1,156,070 0.05 0.07 0.01 -2.49
Nicorandil 36,910 Other antianginal drugs 123,222 0.30 0.53 0.09 -2.45
Fluorometholone 568 Corticosteroids 19,234 0.03 0.09 0.03 -2.19
Risperidone 46,516 Antipsychotic drugs 440,733 0.11 0.15 0.02 -2.12
Hydralazine hydrochloride 2,512 Vasodilator antihypertensive drugs 3,276 0.77 0.88 0.05 -2.09
Lorazepam 21,375 Anxiolytics 174,368 0.12 0.19 0.03 -2.08
Brinzolamide and timolol 1,522 Treatment of glaucoma 246,615 0.01 0.02 0.01 -2.07
Prucalopride 3,817 Other drugs used in constipation 6,917 0.55 0.75 0.10 -2.03
Ganciclovir 133 Antivirals 256 0.52 0.72 0.10 -2.03