Static outliers for Island City 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 Island City PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Hepatitis A/hepatitis B	129	Vaccines and antisera	396	0.33	0.01	0.02	13.82
Twinrix Adult vacc inj 1ml pre-filled syringes : 105 Twinrix Paediatric vacc inj 0.5ml pre-filled syringes : 2 Ambirix vacc inj 1ml pre-filled syringes : 22
Hepatitis A/typhoid vaccine	59	Vaccines and antisera	396	0.15	0.01	0.02	6.76
ViATIM vacc inj 1ml pre-filled syringes : 59
Potassium bicarbonate	1	Oral bicarbonate	94	0.01	0.00	0.00	6.41
Potassium (potassium 6.5mmol) effervescent tablets BPC 1968 : 1
Undecenoates	7	Antifungal preparations	322	0.02	0.00	0.00	5.52
Zinc undecenoate 20% / Undecenoic acid 5% cream : 3 Mycota cream : 4
Haloperidol decanoate	2	Antipsychotic depot injections	2	1.00	0.09	0.18	5.21
Haloperidol decanoate 100mg/1ml inj ampoules : 2

Prescribing where Island City PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Sodium bicarbonate	93	Oral bicarbonate	94	0.99	1.00	0.00	-6.41
Sodium bicarbonate 500mg capsules : 93
Ivermectin	17	Topical preparation for rosacea	33	0.52	0.88	0.12	-3.09
Ivermectin 10mg/g cream : 10 Soolantra 10mg/g cream : 7
Alginic acid compound preparations	1132	Compound Alginates and proprietary indigestion preparations	1155	0.98	1.00	0.01	-2.26
Alginate raft-forming oral suspension sugar free : 14 Sodium algin 500mg/Potassium bicarb 100mg/5ml susp SF : 11 Sodium algin 500mg/Potassium bicarb 100mg chew tab SF : 8 Gaviscon Original Aniseed Relief : 8 Gaviscon Infant oral powder sachets : 152 Gaviscon Peppermint Liquid Relief : 6 Gaviscon Advance oral suspension aniseed (Reckitt Benckiser) : 63 Gaviscon Advance Mint chewable tablets (Reckitt Benckiser) : 42 Gaviscon Double Action chewable tablets mint : 15 Gaviscon Peppermint chewable tablets : 5 Gaviscon Double Action Liquid aniseed : 2 Gaviscon Advance oral susp peppermint (Reckitt Benckiser) : 101 Peptac liquid aniseed : 106 Peptac liquid peppermint : 258 Acidex oral suspension aniseed : 3 Acidex oral suspension peppermint : 1 Acidex Advance oral suspension aniseed : 86 Acidex Advance oral suspension peppermint : 251
Vitamin E	0	Vitamin E	3	0.00	0.73	0.33	-2.24

Betamethasone valerate	620	Topical corticosteroids	3365	0.18	0.28	0.04	-2.19
Betamethasone valerate 0.1% cream : 150 Betamethasone valerate 0.025% cream : 55 Betamethasone valerate 0.1% ointment : 95 Betamethasone valerate 0.025% ointment : 15 Betamethasone valerate 0.1% lotion : 1 Betamethasone valerate 0.1% scalp application : 94 Betamethasone 0.1% foam : 2 Betamethasone valerate 0.1% / Clioquinol 3% cream : 1 Betamethasone valerate 0.1% / Fusidic acid 2% cream : 78 Betamethasone valerate 2.25mg medicated plasters : 1 Betnovate 0.1% cream : 32 Betnovate RD 0.025% cream : 2 Betnovate 0.1% ointment : 35 Betnovate RD 0.025% ointment : 8 Betnovate 0.1% scalp application : 20 Fucibet cream : 15 Betacap 0.1% scalp application : 10 Bettamousse 0.1% cutaneous foam : 2 Betesil 2.25mg medicated plasters : 4