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Prototype Prescribing Outlier Dashboard for Lincolnshire STP

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 Lincolnshire STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Erenumab 8 Treatment of acute migraine 34,930 0.00 0.00 0.00 6.10
Finasteride 1 Shampoos and some other scalp preparations 9,477 0.00 0.00 0.00 5.85
Maraviroc 1 HIV infection 10 0.10 0.00 0.02 5.22
Sodium phenylbutyrate 8 Drugs used in metabolic disorders 67 0.12 0.01 0.02 5.16
Macrogol 4000 1 Osmotic laxatives 102,388 0.00 0.00 0.00 4.94
Bambuterol hydrochloride 255 Selective beta(2)-agonists 235,878 0.00 0.00 0.00 4.56
Aminosalicylic acid 1 Antituberculosis drugs 39 0.03 0.00 0.01 4.54
Oils for the ear 8 Removal of ear wax and other substances 122 0.07 0.01 0.01 4.51
Budesonide 2,880 Drugs used in nasal allergy 74,823 0.04 0.01 0.01 3.90
Mycophenolic sodium 362 Antiproliferative immunosuppressants 11,593 0.03 0.01 0.01 3.63

Prescribing where Lincolnshire STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Miconazole 1,421 Oropharyngeal anti-infective drugs 1,425 1.00 1.00 0.00 -3.39
Oseltamivir phosphate 1 Influenza 2 0.50 0.95 0.18 -2.52
Methadone hydrochloride 39 Opioid dependence 376 0.10 0.59 0.20 -2.48
Sertraline hydrochloride 189,942 Selective serotonin re-uptake inhibitors 518,033 0.37 0.45 0.04 -2.38
Levonorgestrel 237 Oral progestogen-only contraceptives 38,547 0.01 0.01 0.00 -2.29
Nicotine 795 Nicotine dependence 1,709 0.47 0.73 0.12 -2.16
Aciclovir 888 Antiviral preparations 891 1.00 1.00 0.00 -2.13
Mirtazapine 93,516 Other antidepressant drugs 204,516 0.46 0.55 0.05 -2.06
Cocois 448 Preparations for psoriasis 11,390 0.04 0.06 0.01 -1.95
Lamotrigine 31,317 Control of epilepsy 355,853 0.09 0.11 0.01 -1.92