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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Phenazone/lidocaine 100 Otitis externa 9,139 0.01 0.00 0.00 6.30
Alirocumab 59 Lipid-regulating drugs 453,615 0.00 0.00 0.00 6.29
Evolocumab 44 Lipid-regulating drugs 453,615 0.00 0.00 0.00 6.26
Sodium chloride 1 Mouth-washes, gargles and dentifrices 751 0.00 0.00 0.00 6.06
Zuclopenthixol acetate 5 Antipsychotic drugs 50,833 0.00 0.00 0.00 5.45
Methenamine hippurate 8,637 Urinary-tract infections 29,291 0.29 0.04 0.05 5.36
Deferiprone 1 Hypoplastic/haemolytic and renal anaemias 4 0.25 0.01 0.05 5.14
Chlohexidine gluconate (Emollient) 64 Emollients 15,163 0.00 0.00 0.00 4.79
Tetracosactide 3 Hypothalamic & anterior pituitary hormone & antioestrogens 38 0.08 0.01 0.02 4.64
Sodium benzoate 10 Drugs used in metabolic disorders 10 1.00 0.12 0.19 4.56

Prescribing where Somerset STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nitrofurantoin 20,652 Urinary-tract infections 29,291 0.71 0.96 0.05 -5.36
Somatropin 8 Hypothalamic & anterior pituitary hormone & antioestrogens 38 0.21 0.89 0.18 -3.78
Trimethoprim 4,821 Sulfonamides and trimethoprim 6,354 0.76 0.88 0.04 -3.13
Miconazole 783 Oropharyngeal anti-infective drugs 785 1.00 1.00 0.00 -3.03
Sertraline hydrochloride 89,255 Selective serotonin re-uptake inhibitors 255,577 0.35 0.45 0.04 -2.87
Mercaptopurine 278 Antimetabolites 2,014 0.14 0.75 0.24 -2.59
Fusidic acid 132 Antibacterials 5,635 0.02 0.08 0.02 -2.56
Pseudoephedrine hydrochloride 52 Systemic nasal decongestants 60 0.87 0.96 0.04 -2.43
Methylprednisolone acetate 1,599 Local corticosteroid injections 4,595 0.35 0.71 0.15 -2.34
Mycophenolate mofetil 73 Antiproliferative immunosuppressants 3,901 0.02 0.18 0.07 -2.32