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Prototype Prescribing Outlier Dashboard for Bath And North East Somerset, Swindon And Wiltshire 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 Bath And North East Somerset, Swindon And Wiltshire STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Nitazoxanide 1 Some other antibacterials 1,748 0.00 0.00 0.00 6.33
Other oral ulceration and inflammation preparations 1 Drugs for oral ulceration and inflammation 3,244 0.00 0.00 0.00 6.33
Efavirenz 4 HIV infection 14 0.29 0.01 0.04 6.25
Lamivudine and zidovudine 4 HIV infection 14 0.29 0.01 0.04 6.19
Mannitol 3 Mucolytics 26,785 0.00 0.00 0.00 5.70
Diphenhydramine hydrochloride 10 Topical local anaesthetics and antipruritics 2,975 0.00 0.00 0.00 4.99
Cefotaxime sodium 1 Cephalosporins 8,425 0.00 0.00 0.00 4.96
Mometasone furoate 150 Corticosteroids (respiratory) 205,778 0.00 0.00 0.00 4.66
Betamethasone sodium phosphate 2,457 Otitis externa 14,305 0.17 0.04 0.03 4.53
Sodium citrate 3 Antacids and simeticone 328 0.01 0.00 0.00 4.50

Prescribing where Bath And North East Somerset, Swindon And Wiltshire STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Midazolam hydrochloride 269 Drugs used in status epilepticus 743 0.36 0.78 0.10 -4.40
Metronidazole 3,311 Metronidazole, tinidazole and ornidazole 3,313 1.00 1.00 0.00 -2.65
Memantine hydrochloride 7,211 Drugs for dementia 34,585 0.21 0.39 0.07 -2.64
Melatonin 1,725 Hypnotics 70,976 0.02 0.17 0.06 -2.42
Entecavir 3 Chronic hepatitis B 5 0.60 0.93 0.14 -2.39
Montelukast 38,933 Leukotriene receptor antagonists 38,935 1.00 1.00 0.00 -2.07
Dexamethasone 10,049 Otitis externa 14,305 0.70 0.78 0.04 -1.85
Vigabatrin 20 Control of epilepsy 273,708 0.00 0.00 0.00 -1.84
Artificial saliva 40 Treatment of dry mouth 691 0.06 0.19 0.07 -1.80
Octreotide acetate 27 Somatostatin analogues 80 0.34 0.67 0.19 -1.77