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Prototype Prescribing Outlier Dashboard for Humber, Coast And Vale 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 Humber, Coast And Vale STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Flunisolide 4 Drugs used in nasal allergy 150,906 0.00 0.00 0.00 6.33
Other anti-inflammatory preparations 1 Other anti-inflammatory preparations 20,008 0.00 0.00 0.00 6.33
Rilpivirine 1 HIV infection 21 0.05 0.00 0.01 6.10
Mometasone/glycopyrronium/indacaterol 210 Corticosteroids (respiratory) 442,916 0.00 0.00 0.00 5.53
Potassium chloride 3 Electrolytes and water 5,038 0.00 0.00 0.00 5.53
Carvedilol 41,498 Beta-adrenoceptor blocking drugs 927,964 0.04 0.01 0.01 5.08
Timolol 3,902 Beta-adrenoceptor blocking drugs 927,964 0.00 0.00 0.00 4.85
Fosphenytoin sodium 1 Drugs used in status epilepticus 1,300 0.00 0.00 0.00 4.84
Isotretinoin 1 Topical preparations for acne 24,998 0.00 0.00 0.00 4.62
Other bisphosphonate and other preparations 42 Bisphosphonates and other drugs 124,133 0.00 0.00 0.00 4.40

Prescribing where Humber, Coast And Vale STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Menadiol sodium phosphate 25 Vitamin K 259 0.10 0.46 0.15 -2.34
Other amino acidandnutritional agent preparations 837 Amino acids and nutritional agents 1,047 0.80 0.97 0.08 -2.18
Lamivudine 0 HIV infection 21 0.00 0.58 0.27 -2.15
    Salbutamol 444,081 Selective beta(2)-agonists 520,202 0.85 0.90 0.02 -2.08
    Dexamethasone 3,397 Corticosteroids 13,540 0.25 0.51 0.13 -2.06
    Amiloride hydrochloride 1,504 Potassium-sparing diuretics and aldosterone antagonists 89,772 0.02 0.03 0.01 -2.03
    Benzoyl peroxide and clindamycin phosphate 7,145 Topical preparations for acne 24,998 0.29 0.37 0.04 -1.93
    Neomycin sulfate 5,425 Nasal preparations for infection 7,268 0.75 0.83 0.04 -1.92
    Sumatriptan succinate 39,991 Treatment of acute migraine 67,339 0.59 0.65 0.03 -1.86
    Naproxen 162,359 Non-steroidal anti-inflammatory drugs 261,555 0.62 0.69 0.04 -1.82