Static outliers for NHS Birmingham And Solihull 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 Birmingham And Solihull CCG is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other oral ulceration and inflammation preparations☰	1	Drugs for oral ulceration and inflammation	7686	0.00	0.0	0.00	10.20
Chlorobutanol 1% tincture : 1
Ambrisentan☰	1	Vasodilator antihypertensive drugs	1185	0.00	0.0	0.00	9.66
Ambrisentan 5mg tablets : 1
Emulsifying wax☰	3	Vehicles	14	0.21	0.0	0.02	9.43
Emulsifying wax : 3
Hamamelis☰	3	Oxidisers and dyes	79	0.04	0.0	0.00	8.82
Hamamelis water : 3
Abacavir☰	1	HIV infection	45	0.02	0.0	0.00	8.37
Abacavir 300mg tablets : 1

Prescribing where NHS Birmingham And Solihull CCG is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Warfarin sodium☰	7460	Oral anticoagulants	99235	0.08	0.25	0.07	-2.53
Warfarin 1mg tablets : 2759 Warfarin 3mg tablets : 2088 Warfarin 5mg tablets : 1067 Warfarin 500microgram tablets : 1541 Warfarin 1mg/ml oral suspension sugar free : 5
Codeine phosphate☰	1027	Cough suppressants	1967	0.52	0.78	0.11	-2.36
Codeine 15mg/5ml linctus : 242 Codeine 15mg/5ml linctus sugar free : 642 Galcodine 15mg/5ml linctus : 143
Fexofenadine hydrochloride☰	33104	Antihistamines	142844	0.23	0.37	0.07	-1.98
Fexofenadine 120mg tablets : 13675 Fexofenadine 180mg tablets : 18647 Fexofenadine 30mg tablets : 553 Fexofenadine 180mg/5ml oral liquid : 3 Telfast 120mg tablets : 109 Telfast 180mg tablets : 99 Telfast 30mg tablets : 18
Alfentanil hydrochloride☰	7	Opioid analgesics	14	0.50	0.92	0.21	-1.98
Alfentanil 1mg/2ml solution for injection ampoules : 6 Alfentanil 5mg/10ml solution for injection ampoules : 1
Co-cyprindiol (Cyprote acetate/ethinylestradiol)☰	325	Oral preparations for acne	505	0.64	0.94	0.15	-1.97
Co-cyprindiol 2000microgram/35microgram tablets : 159 Dianette tablets (Bayer) : 162 Clairette 2000/35 tablets : 4