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Prototype Prescribing Outlier Dashboard for The Black Country And West Birmingham 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 The Black Country And West Birmingham STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Upadacitinib 4 Rheumatic disease suppressant drugs 41,840 0.00 0.00 0.00 6.33
Other minor cut and abrasion preparations 8 Preparations for minor cuts and abrasions 322 0.02 0.00 0.00 6.33
Cannabidiol 2 Control of epilepsy 438,465 0.00 0.00 0.00 6.33
Sulfinpyrazone 8 Gout and cytotoxic induced hyperiuicaemia 89,110 0.00 0.00 0.00 6.24
Vitamin B and C injection 139 Thiamine hydrochloride (B1) 46,577 0.00 0.00 0.00 6.08
Calcium polystyrene sulfonate 259 Oral potassium 1,779 0.15 0.01 0.02 6.03
Zidovudine 7 HIV infection 71 0.10 0.00 0.02 5.86
Salbutamol 1,065 Compound bronchodilator preparations 18,788 0.06 0.01 0.01 4.87
Insulin glargine/lixisenatide 171 Intermediate and long-acting insulins 96,962 0.00 0.00 0.00 4.55
Oxandrolone 7 Anabolic steroids 22 0.32 0.02 0.07 4.39

Prescribing where The Black Country And West Birmingham STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Thiamine hydrochloride 46,438 Thiamine hydrochloride (B1) 46,577 1.00 1.00 0.00 -6.08
Potassium chloride 1,466 Oral potassium 1,779 0.82 0.97 0.03 -4.88
Prasterone 15 Anabolic steroids 22 0.68 0.97 0.07 -4.08
Valganciclovir hydrochloride 9 Cytomegalovirus infection 13 0.69 0.98 0.09 -3.36
Glucosamine hydrochloride (Rheumatic) 0 Other drugs for rheumatic diseases 1 0.00 0.90 0.28 -3.21
    Progesterone 4,583 Progestogens and progesterone receptor modulators 12,267 0.37 0.65 0.11 -2.65
    Ivermectin 540 Topical preparation for rosacea 714 0.76 0.89 0.05 -2.58
    Lymecycline 8,061 Tetracyclines 69,992 0.12 0.23 0.05 -2.27
    Flecainide acetate 3,146 Drugs for arrhythmias 12,033 0.26 0.48 0.10 -2.25
    Lamotrigine 37,182 Control of epilepsy 438,465 0.08 0.11 0.01 -2.17