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

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Erlotinib 1 Other antineoplastic drugs 2,276 0.00 0.00 0.00 6.33
Terazosin hydrochloride 8 Drugs for urinary retention 85,931 0.00 0.00 0.00 6.31
Lactic acid 5 Emollients 54,618 0.00 0.00 0.00 5.96
Chloroquine phosphate with proguanil hydrochloride 1 Antimalarials 11,183 0.00 0.00 0.00 5.94
Bosentan 9 Vasodilator antihypertensive drugs 870 0.01 0.00 0.00 5.91
Vericiguat 1 Vasodilator antihypertensive drugs 870 0.00 0.00 0.00 5.63
Urine testing reagents 3,293 Diabetic diagnostic and monitoring agents 55,466 0.06 0.01 0.01 5.26
Lumacaftor/ivacaftor 1 Mucolytics 19,028 0.00 0.00 0.00 5.20
Benzyl benzoate 1 Parasiticidal preparations 600 0.00 0.00 0.00 5.00
Other osmotic laxative preparations 9 Osmotic laxatives 87,110 0.00 0.00 0.00 4.60

Prescribing where Dorset STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Somatropin 10 Hypothalamic & anterior pituitary hormone & antioestrogens 64 0.16 0.89 0.18 -4.08
Phenoxymethylpenicillin (Penicillin V) 13,115 Benzylpenicillin and phenoxymethylpenicillin 13,121 1.00 1.00 0.00 -3.84
Hydrogen peroxide 14 Preparations for minor cuts and abrasions 106 0.13 0.49 0.13 -2.67
Amiodarone hydrochloride 1,892 Drugs for arrhythmias 8,197 0.23 0.46 0.09 -2.46
Etonogestrel 34 Parenteral progestogen-only contraceptives 5,299 0.01 0.14 0.05 -2.46
Methylprednisolone acetate 3,080 Local corticosteroid injections 9,319 0.33 0.71 0.15 -2.46
Methadone hydrochloride 39 Opioid dependence 327 0.12 0.59 0.20 -2.40
Aciclovir 1,075 Antiviral preparations 1,079 1.00 1.00 0.00 -2.40
Ferrous fumarate 9,228 Oral iron 54,064 0.17 0.56 0.17 -2.35
Glucose blood testing reagents 50,249 Diabetic diagnostic and monitoring agents 55,466 0.91 0.94 0.02 -2.32