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Prototype Prescribing Outlier Dashboard for Devon 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 Devon STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Levobupivacaine hydrochloride 130 Local anaesthetics 20,482 0.01 0.00 0.00 6.33
Epoetin zeta 2 Hypoplastic/haemolytic and renal anaemias 18 0.11 0.00 0.02 6.07
Gluten free pastas 4 Foods for special diets 9,199 0.00 0.00 0.00 6.00
Gluten free/wheat free cereals 2 Foods for special diets 9,199 0.00 0.00 0.00 5.53
Flumetasone pivalate 333 Otitis externa 19,724 0.02 0.00 0.00 5.52
Gripe mixtures 1 Sodium bicarbonate 56 0.02 0.00 0.00 5.26
Levofloxacin 1,372 Quinolones 4,754 0.29 0.05 0.05 5.07
Other vitamin B compound preparations 22 Vitamin B compound 11,502 0.00 0.00 0.00 4.85
Liquefied phenol 1 Phenolics 3 0.33 0.01 0.07 4.80
Ruxolitinib 2 Other antineoplastic drugs 1,494 0.00 0.00 0.00 4.58

Prescribing where Devon STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium bicarbonate 55 Sodium bicarbonate 56 0.98 1.00 0.00 -5.26
Vitamin B compound 11,480 Vitamin B compound 11,502 1.00 1.00 0.00 -4.85
Ciprofloxacin 2,989 Quinolones 4,754 0.63 0.86 0.06 -3.93
Dexamethasone 13,061 Otitis externa 19,724 0.66 0.78 0.04 -2.83
Zolmitriptan 3,737 Treatment of acute migraine 51,207 0.07 0.13 0.02 -2.39
Fusidic acid 359 Antibacterials 13,283 0.03 0.08 0.02 -2.38
Fexofenadine hydrochloride 33,711 Antihistamines 169,747 0.20 0.35 0.07 -2.30
Senna 39,769 Stimulant laxatives 110,838 0.36 0.56 0.09 -2.21
Levodopa/carbidopa/entacapone 669 Dopaminergic drugs used in parkinsonism 66,746 0.01 0.03 0.01 -2.18
Propylthiouracil 264 Antithyroid drugs 7,969 0.03 0.07 0.02 -2.14