Static outliers for NHS Stockport 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 Stockport CCG is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Chloroquine phosphate☰	52	Antimalarials	4573	0.01	0.0	0.0	9.34
Chloroquine phosphate 250mg tablets : 52
Acebutolol hydrochloride☰	164	Beta-adrenoceptor blocking drugs	109211	0.00	0.0	0.0	6.79
Acebutolol 100mg capsules : 44 Acebutolol 200mg capsules : 77 Acebutolol 400mg tablets : 38 Sectral 100mg capsules : 5
Amphotericin☰	2	Polyene antifungals	1258	0.00	0.0	0.0	5.96
Fungizone 50mg pdr for concentrate for inf vials : 2
Nicardipine hydrochloride☰	187	Calcium-channel blockers	104150	0.00	0.0	0.0	5.55
Nicardipine 20mg capsules : 89 Nicardipine 30mg capsules : 92 Cardene 20mg capsules : 1 Cardene 30mg capsules : 5
Torasemide☰	209	Loop diuretics	29655	0.01	0.0	0.0	4.61
Torasemide 2.5mg tablets : 47 Torasemide 5mg tablets : 103 Torasemide 10mg tablets : 59

Prescribing where NHS Stockport CCG is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nystatin☰	1256	Polyene antifungals	1258	1.00	1.00	0.00	-5.96
Nystatin 100,000units/ml oral suspension : 996 Nystan 100,000units/ml oral suspension (ready mixed) : 260
Clonidine hydrochloride☰	180	Prophylaxis of migraine	1228	0.15	0.36	0.07	-2.95
Clonidine 25microgram tablets : 180
Hydralazine hydrochloride☰	153	Vasodilator antihypertensive drugs	248	0.62	0.86	0.10	-2.59
Hydralazine 25mg tablets : 101 Hydralazine 50mg tablets : 52
Mercaptopurine☰	83	Antimetabolites	355	0.23	0.81	0.23	-2.48
Mercaptopurine 50mg tablets : 83
Famotidine☰	2773	H2-Receptor antagonists	4237	0.65	0.81	0.07	-2.17
Famotidine 20mg tablets : 1923 Famotidine 40mg tablets : 850