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Prototype Prescribing Outlier Dashboard for Frimley 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 Frimley Health & Care (STP) is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sarilumab 2 Rheumatic disease suppressant drugs 18,525 0.00 0.0 0.00 6.33
Fampridine 6 Drugs which enhance neuromuscular transmission 405 0.01 0.0 0.00 6.31
Amikacin 1 Aminoglycosides 8 0.12 0.0 0.02 6.27
Ustekinumab (Psoriasis) 1 Drugs affecting the immune response 1,350 0.00 0.0 0.00 6.09
Phenprocoumon 1 Oral anticoagulants 124,769 0.00 0.0 0.00 6.08
Abacavir 1 HIV infection 19 0.05 0.0 0.01 6.04
Isavuconazole 1 Triazole antifungals 3,765 0.00 0.0 0.00 5.91
Chorionic gonadotrophin 1 Hypothalamic & anterior pituitary hormone & antioestrogens 502 0.00 0.0 0.00 5.52
Pentazocine hydrochloride 60 Opioid analgesics 106,564 0.00 0.0 0.00 5.43
Coal tar and corticosteroid preparations 1 Preparations for psoriasis 7,105 0.00 0.0 0.00 4.83

Prescribing where Frimley Health & Care (STP) is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pyridostigmine bromide 399 Drugs which enhance neuromuscular transmission 405 0.99 1.00 0.00 -5.68
Captopril 105 Angiotensin-converting enzyme inhibitors 264,441 0.00 0.00 0.00 -2.31
Brinzolamide and timolol 407 Treatment of glaucoma 64,046 0.01 0.02 0.01 -2.05
Hypromellose 4,906 Tear deficiency, eye lubricant/astringent 15,124 0.32 0.45 0.07 -1.94
Sulfasalazine 2,540 Aminosalicylates 11,289 0.22 0.35 0.06 -1.89
Ibuprofen 3,624 Non-steroidal anti-inflammatory drugs 61,298 0.06 0.11 0.03 -1.83
Dimeticone (Parasiticidal) 2 Parasiticidal preparations 598 0.00 0.03 0.01 -1.81
Lithium citrate 15 Drugs used for mania and hypomania 8,887 0.00 0.01 0.00 -1.79
Magnesium aspartate 139 Magnesium 591 0.24 0.50 0.15 -1.74
Other multivitamin preparations 3,229 Multivitamin preparations 5,093 0.63 0.80 0.09 -1.73