Static outliers for NHS Bury CCG

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. 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.

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 using the BNF subparagraph as a denominator, for prescriptions dispensed between April 2021 and August 2021. We then calculate the mean and standard deviation for each numerator and denominator pair across all practices/CCGs/PCNs/STPs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given practice/CCG/PCN/STP is from the population mean. We then rank your “z-scores” to find the top 5 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.

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. Our full analytical method code is openly available on GitHub here.

The DataLab is keen to hear your feedback on the results. You can do this by completing the following survey or emailing us at ebmdatalab@phc.ox.ac.uk. Please DO NOT INCLUDE IDENTIFIABLE PATIENT information in your feedback. All feedback is helpful, you can send short or detailed feedback.

Prescribing where NHS Bury CCG is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Tocilizumab☰	1	Rheumatic disease suppressant drugs	4265	0.00	0.0	0.00	10.20
Tocilizumab 200mg/10ml solution for infusion vials : 1
Hexylresorcinol☰	1	Lozenges and sprays	13	0.08	0.0	0.01	9.43
Strepsils Extra Triple Action Blackcurrant 2.4mg lozenges : 1
Erythromycin stearate☰	68	Macrolides	3942	0.02	0.0	0.00	7.02
Erythromycin stearate 250mg tablets : 19 Erythromycin stearate 500mg tablets : 39 Erythrocin 250 tablets : 7 Erythrocin 500 tablets : 3
Co-danthrusate (Dantron/docusate sodium)☰	5	Stimulant laxatives	8973	0.00	0.0	0.00	5.32
Co-danthrusate 50mg/60mg/5ml oral suspension sugar free : 5
Fidaxomicin☰	3	Some other antibacterials	182	0.02	0.0	0.00	5.30
Fidaxomicin 200mg tablets : 3

Prescribing where NHS Bury CCG is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Folic acid☰	6572	Drugs used in megaloblastic anaemias	16706	0.39	0.67	0.12	-2.34
Folic acid 5mg/5ml oral solution sugar free : 15 Folic acid 5mg tablets : 6276 Folic acid 400microgram tablets : 166 Folic acid 2.5mg/5ml oral solution sugar free : 114 FolicA 2.5mg/5ml oral solution : 1
Cocois☰	62	Preparations for psoriasis	2086	0.03	0.06	0.01	-2.16
Cocois ointment : 24 Sebco ointment : 38
Aluminium chloride☰	99	Antiperspirants	103	0.96	0.99	0.01	-2.13
Aluminium chloride 20% solution : 35 Aluminium chloride 20% spray : 8 Anhydrol Forte 20% solution : 20 Driclor 20% solution : 36
Gliclazide☰	6083	Sulfonylureas	8976	0.68	0.92	0.11	-2.10
Gliclazide 80mg tablets : 4115 Gliclazide 30mg modified-release tablets : 426 Gliclazide 40mg tablets : 1403 Gliclazide 60mg modified-release tablets : 100 Gliclazide 160mg tablets : 29 Diamicron 30mg MR tablets : 3 Zicron 40mg tablets : 7
Hydralazine hydrochloride☰	57	Vasodilator antihypertensive drugs	85	0.67	0.86	0.10	-2.03
Hydralazine 25mg tablets : 41 Hydralazine 50mg tablets : 16