Static outliers for Chorley Central 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 Chorley Central PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gluten free/low protein drink 2 Foods for special diets 298 0.01 0.00 0.00 4.36
Magnesium oxide 3 Antacids and simeticone 5 0.60 0.06 0.15 3.72
Sildenafil(Vasodilator Antihypertensive) 5 Vasodilator antihypertensive drugs 20 0.25 0.02 0.06 3.70
Silver nitrate 7 Preparations for warts and calluses 19 0.37 0.07 0.08 3.62
Nicardipine hydrochloride 36 Calcium-channel blockers 20612 0.00 0.00 0.00 3.42

Prescribing where Chorley Central PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sodium cromoglicate 94 Other anti-inflammatory preparations 240 0.39 0.67 0.11 -2.45
Ganciclovir 0 Antivirals 3 0.00 0.70 0.34 -2.06
Salbutamol 9968 Selective beta(2)-agonists 11876 0.84 0.90 0.03 -2.02
Salbutamol 100micrograms/dose inhaler CFC free : 6440
Salbutamol 200micrograms/dose dry powder inhaler : 42
Salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials : 179
Salbutamol 5mg/2.5ml nebuliser liquid unit dose vials : 96
Salbutamol 2mg/5ml oral solution sugar free : 3
Salbutamol 100micrograms/dose breath actuated inh CFC free : 414
Salbutamol 100micrograms/dose dry powder inhaler : 90
Salbutamol 100micrograms/dose dry pdr inhalation cartridge : 1
Ventolin 200micrograms/dose Accuhaler : 136
Ventolin 100micrograms/dose Evohaler : 1635
Ventolin 2.5mg Nebules : 28
Ventolin 5mg Nebules : 19
Salamol 100micrograms/dose inhaler CFC free (Teva) : 22
Salamol 100micrograms/dose Easi-Breathe inhaler : 82
Airomir 100micrograms/dose Autohaler : 22
Easyhaler Salbutamol sulfate 100micrograms/dose dry pdr inh : 682
Easyhaler Salbutamol sulfate 200micrograms/dose dry pdr inh : 77
Hydrocortisone 80 Copound haemorrhoidal preparations with corticosteroid 365 0.22 0.58 0.18 -2.00
Ketoconazole 83 Shampoos and some other scalp preparations 248 0.33 0.50 0.08 -1.99