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Prototype Prescribing Outlier Dashboard for Cambridgeshire And Peterborough 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 Cambridgeshire And Peterborough STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Urofollitropin 3 Hypothalamic & anterior pituitary hormone & antioestrogens 1,039 0.00 0.00 0.00 6.33
Chlortalidone 897 Thiazides and related diuretics 118,078 0.01 0.00 0.00 5.76
Menthol 6 Lozenges and sprays 23 0.26 0.02 0.04 5.65
Sucrase 5 Drugs used in metabolic disorders 47 0.11 0.00 0.02 5.52
Ketoprofen 11,095 Rubefacients, topical NSAIDS, capsaicin and poultice 44,794 0.25 0.03 0.04 5.42
Hydrocortisone butyrate 1,547 Topical corticosteroids 93,326 0.02 0.00 0.00 5.20
Other lozenge and spray preparations 2 Lozenges and sprays 23 0.09 0.01 0.02 4.79
Other vitamin A preparations 0906011 38 Vitamin A 205 0.19 0.03 0.03 4.62
Letermovir 2 Cytomegalovirus infection 5 0.40 0.02 0.09 4.45
Paricalcitol 46 Vitamin D 221,972 0.00 0.00 0.00 4.22

Prescribing where Cambridgeshire And Peterborough STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Valganciclovir hydrochloride 3 Cytomegalovirus infection 5 0.60 0.98 0.09 -4.45
Carbimazole 5,789 Antithyroid drugs 6,484 0.89 0.93 0.02 -2.76
Clopidogrel 78,237 Antiplatelet drugs 313,408 0.25 0.33 0.03 -2.72
Clotrimazole 5,659 Vaginal and vulval infections 6,770 0.84 0.90 0.03 -2.18
Acamprosate calcium 894 Alcohol dependence 1,449 0.62 0.83 0.10 -2.10
Phased formulations of ethinylestradiol 76 Combined hormonal contraceptives 31,037 0.00 0.01 0.00 -2.08
Fluticasone furoate 4,247 Drugs used in nasal allergy 60,636 0.07 0.23 0.08 -2.06
Calcium carbonate 2,911 Calcium supplements 3,169 0.92 0.96 0.02 -2.05
Tramadol hydrochloride 38,545 Opioid analgesics 206,883 0.19 0.26 0.04 -2.05
Ramipril 231,688 Angiotensin-converting enzyme inhibitors 471,266 0.49 0.70 0.10 -2.04