Static outliers for NHS West Essex 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 West Essex CCG is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Rimexolone	1	Corticosteroids	1543	0.0	0.00	0.00	10.20
Vexol 10mg/ml eye drops : 1
Methylprednisolone sodium succinate	8	Use of corticosteroids	15705	0.0	0.00	0.00	8.77
Methylprednisolone sodium succinate 40mg inj vials : 8
Indoramin	3	Alpha-adrenoceptor blocking drugs	15496	0.0	0.00	0.00	7.54
Indoramin 25mg tablets : 3
Amylmetacresol	1	Lozenges and sprays	1	1.0	0.07	0.15	6.35
Strepsils Honey and Lemon lozenges : 1
Magnesium sulfate	7	Osmotic laxatives	19988	0.0	0.00	0.00	6.18
Magnesium sulfate powder : 7

Prescribing where NHS West Essex CCG is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Aluminium chloride	74	Antiperspirants	79	0.94	0.99	0.01	-3.80
Aluminium chloride 20% solution : 33 Aluminium chloride 20% spray : 11 Anhydrol Forte 20% solution : 15 Driclor 20% solution : 15
Potassium permanganate	9	Oxidisers and dyes	15	0.60	0.94	0.10	-3.27
Potassium permanganate 400mg tablets for cutaneous solution : 9
Phenoxymethylpenicillin (Penicillin V)	4055	Benzylpenicillin and phenoxymethylpenicillin	4057	1.00	1.00	0.00	-3.13
Phenoxymethylpenicillin 125mg/5ml oral solution : 446 Phenoxymethylpenicillin 250mg/5ml oral solution : 379 Phenoxymethylpenicillin 250mg tablets : 2917 Phenoxymethylpenicillin 125mg/5ml oral solution sugar free : 167 Phenoxymethylpenicillin 250mg/5ml oral solution sugar free : 146
Pizotifen malate	665	Prophylaxis of migraine	1572	0.42	0.64	0.07	-3.04
Pizotifen 500microgram tablets : 392 Pizotifen 1.5mg tablets : 273
Iron dextran	0	Parenteral iron	1	0.00	0.87	0.29	-2.97