Static outliers for Stalybridge PCN

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 Stalybridge PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other antiperspirant preparations☰	2	Antiperspirants	35	0.06	0.00	0.00	17.23
Triple Dry Anti-perspirant roll-on : 2
Pyrazinamide☰	1	Antituberculosis drugs	11	0.09	0.00	0.01	7.19
Pyrazinamide 500mg tablets : 1
Hamamelis☰	6	Soothing haemorrhoidal preparations	47	0.13	0.00	0.02	6.24
Preparation H 50% clear gel : 6
Triamterene with loop diuretics☰	16	Potassium sparing diuretics and compounds	82	0.20	0.01	0.03	5.38
Triamterene 50mg / Furosemide 40mg tablets : 10 Frusene 50mg/40mg tablets : 6
Promazine hydrochloride☰	542	Antipsychotic drugs	3823	0.14	0.01	0.03	4.14
Promazine 25mg/5ml oral solution : 304 Promazine 25mg tablets : 153 Promazine 50mg tablets : 23 Promazine 50mg/5ml oral solution : 62

Prescribing where Stalybridge PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Trimethoprim☰	200	Sulfonamides and trimethoprim	293	0.68	0.87	0.07	-2.78
Trimethoprim 100mg tablets : 51 Trimethoprim 200mg tablets : 92 Trimethoprim 50mg/5ml oral suspension sugar free : 57
Folic acid☰	1837	Drugs used in megaloblastic anaemias	4908	0.37	0.68	0.13	-2.33
Folic acid 5mg/5ml oral solution sugar free : 6 Folic acid 5mg tablets : 1765 Folic acid 400microgram tablets : 55 Folic acid 2.5mg/5ml oral solution sugar free : 11
Donepezil hydrochloride☰	166	Drugs for dementia	646	0.26	0.49	0.11	-2.04
Donepezil 5mg tablets : 34 Donepezil 10mg tablets : 127 Donepezil 10mg orodispersible tablets sugar free : 5
Ciprofloxacin☰	54	Quinolones	79	0.68	0.85	0.08	-2.02
Ciprofloxacin 250mg tablets : 7 Ciprofloxacin 500mg tablets : 45 Ciprofloxacin 750mg tablets : 1 Ciprofloxacin 250mg/5ml oral suspension : 1
Lorazepam☰	129	Anxiolytics	2007	0.06	0.19	0.07	-1.89
Lorazepam 1mg tablets : 101 Lorazepam 500microgram tablets : 28