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Prototype Prescribing Outlier Dashboard for North London Partners In Health & Care (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 North London Partners In Health & Care (STP) is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other vehicle and emulsifying agent preparations 1 Vehicles 4,738 0.00 0.0 0.00 6.33
Erythromycin 1 Antibacterials 15,542 0.00 0.0 0.00 6.33
Lopinavir and ritonavir 1 HIV infection 357 0.00 0.0 0.00 6.25
Hydrocortisone 4 Corticosteroids 1,164 0.00 0.0 0.00 6.01
Empagliflozin/linagliptin 507 Other antidiabetic drugs 218,395 0.00 0.0 0.00 5.77
Triamterene 3 Potassium-sparing diuretics and aldosterone antagonists 49,387 0.00 0.0 0.00 5.42
Toremifene citrate 11 Breast cancer 23,645 0.00 0.0 0.00 4.54
Sodium bicarbonate 46 Electrolytes and water 1,440 0.03 0.0 0.01 4.53
Arnica montana 43 Rubefacients, topical NSAIDS, capsaicin and poultice 91,816 0.00 0.0 0.00 4.47
Tryptophan 54 Other antidepressant drugs 191,915 0.00 0.0 0.00 4.40

Prescribing where North London Partners In Health & Care (STP) is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lidocaine hydrochloride 5,765 Local anaesthetics 6,828 0.84 0.92 0.03 -3.01
Terbinafine hydrochloride 4,813 Other antifungals 4,918 0.98 0.99 0.01 -2.56
Pregabalin 53,554 Control of epilepsy 302,065 0.18 0.27 0.04 -2.56
Prednisolone 48,398 Use of corticosteroids 56,418 0.86 0.89 0.01 -2.44
Fluconazole 5,290 Triazole antifungals 6,666 0.79 0.86 0.03 -2.24
Methotrexate 12,224 Rheumatic disease suppressant drugs 27,972 0.44 0.60 0.07 -2.23
Aciclovir 12,625 Herpes simplex and varicella-zoster 13,894 0.91 0.95 0.02 -2.20
Vitamin A 401 Vitamin A 735 0.55 0.82 0.13 -2.16
Morphine sulfate 20,728 Opioid analgesics 158,059 0.13 0.22 0.04 -2.15
Alginic acid compound preparations 46,005 Compound Alginates and proprietary indigestion preparations 46,325 0.99 1.00 0.00 -2.15