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Prototype Prescribing Outlier Dashboard for Cumbria And North East 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 Cumbria And North East STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium aurothiomalate 1 Rheumatic disease suppressant drugs 114,367 0.00 0.00 0.00 6.33
Emedastine 1 Other anti-inflammatory preparations 32,663 0.00 0.00 0.00 6.33
Meningococcal C vaccine 1 Vaccines and antisera 686,083 0.00 0.00 0.00 6.33
Nandrolone decanoate 4 Anabolic steroids 23 0.17 0.01 0.03 6.05
Dronedarone hydrochloride 2,661 Drugs for arrhythmias 22,875 0.12 0.02 0.02 4.65
Zinc paste 2 Barrier preparations 7,525 0.00 0.00 0.00 4.59
Balsalazide sodium 6,409 Aminosalicylates 101,256 0.06 0.01 0.01 4.42
Apremilast 28 Rheumatic disease suppressant drugs 114,367 0.00 0.00 0.00 4.09
Degarelix 4,902 Prostate cancer and gonadorelin analogues 31,921 0.15 0.03 0.03 3.87
Benzatropine mesilate 57 Antimuscarinic drugs used in parkinsonism 45,171 0.00 0.00 0.00 3.77

Prescribing where Cumbria And North East STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Co-codamol (Codeine phosphate/paracetamol) 270,523 Non-opioid analgesics and compound preparations 1,353,879 0.20 0.45 0.08 -3.00
Prochlorperazine maleate 48,674 Drugs used in nausea and vertigo 269,338 0.18 0.25 0.02 -2.86
Amitriptyline hydrochloride 686,647 Tricyclic and related antidepressant drugs 906,253 0.76 0.85 0.03 -2.86
Zopiclone 115,121 Hypnotics 242,427 0.47 0.62 0.05 -2.82
Clarithromycin 42,546 Macrolides 121,182 0.35 0.59 0.09 -2.75
Riluzole 254 Essential tremor,chorea,tics and related disorders 2,348 0.11 0.40 0.11 -2.74
Other multivitamin preparations 26,611 Multivitamin preparations 46,656 0.57 0.80 0.09 -2.41
Trimethoprim 48,797 Sulfonamides and trimethoprim 61,528 0.79 0.88 0.04 -2.24
Fentanyl 26,800 Opioid analgesics 1,506,597 0.02 0.04 0.01 -2.12
Atropine sulfate 1,628 Mydriatics and cycloplegics 2,733 0.60 0.75 0.07 -2.11