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Prototype Prescribing Outlier Dashboard for Herefordshire And Worcestershire 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 Herefordshire And Worcestershire STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cholesterol 20 Drugs used in metabolic disorders 25 0.80 0.02 0.12 6.31
Fenofibrate/simvastatin 4 Lipid-regulating drugs 594,804 0.00 0.00 0.00 5.60
Magnesium sulfate 31 Magnesium 968 0.03 0.00 0.01 5.40
Alitretinoin 4 Preparations for eczema 8 0.50 0.03 0.09 5.33
Benperidol 205 Antipsychotic drugs 93,756 0.00 0.00 0.00 4.98
Acitretin 275 Preparations for psoriasis 9,479 0.03 0.01 0.01 4.64
Choriogonadotropin alfa 11 Hypothalamic & anterior pituitary hormone & antioestrogens 266 0.04 0.00 0.01 4.62
Other alcohol and saline preparations 1 Alcohols and saline 1 1.00 0.05 0.21 4.56
Chlorhexidine acetate 2 Chlorhexidine salts 1,205 0.00 0.00 0.00 4.02
Mesna 1 Drugs for cytotoxic-induced side-effects 16 0.06 0.00 0.02 3.70

Prescribing where Herefordshire And Worcestershire STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chlorhexidine gluconate 1,203 Chlorhexidine salts 1,205 1.00 1.00 0.00 -4.02
Alcohol 0 Alcohols and saline 1 0.00 0.87 0.23 -3.84
    Calcium folinate 15 Drugs for cytotoxic-induced side-effects 16 0.94 1.00 0.02 -3.70
    Gamolenic acid 4 Preparations for eczema 8 0.50 0.91 0.12 -3.38
    Phenoxymethylpenicillin (Penicillin V) 14,535 Benzylpenicillin and phenoxymethylpenicillin 14,540 1.00 1.00 0.00 -2.61
    Erythromycin 396 Topical preparations for acne 9,154 0.04 0.12 0.03 -2.36
    Amlodipine 224,373 Calcium-channel blockers 365,874 0.61 0.74 0.06 -2.34
    Liquid paraffin 0 Faecal softeners 4 0.00 0.61 0.28 -2.16
      Ketoconazole 211 Antifungal preparations 11,283 0.02 0.04 0.01 -2.04
      Prasterone 5 Anabolic steroids 6 0.83 0.97 0.07 -1.96