Static outliers for Hull Nexus 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 Hull Nexus PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other bisphosphonate and other preparations☰	30	Bisphosphonates and other drugs	2758	0.01	0.00	0.00	43.02
Actonel Combi 35mg tab and 1000mg/880unit efferv gran sach : 30
Timolol☰	349	Beta-adrenoceptor blocking drugs	28830	0.01	0.00	0.00	11.40
Timolol 10mg tablets : 349
Cefixime☰	3	Cephalosporins	79	0.04	0.00	0.00	8.32
Cefixime 200mg tablets : 3
Carvedilol☰	2199	Beta-adrenoceptor blocking drugs	28830	0.08	0.01	0.01	6.87
Carvedilol 12.5mg tablets : 612 Carvedilol 25mg tablets : 390 Carvedilol 3.125mg tablets : 585 Carvedilol 6.25mg tablets : 612
Potassium bicarbonate☰	1	Oral bicarbonate	92	0.01	0.00	0.00	6.56
Potassium (potassium 6.5mmol) effervescent tablets BPC 1968 : 1

Prescribing where Hull Nexus PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sodium bicarbonate☰	91	Oral bicarbonate	92	0.99	1.00	0.00	-6.56
Sodium bicarbonate 500mg capsules : 90 Sodium bicarbonate 500mg gastro-resistant capsules : 1
Cefalexin☰	51	Cephalosporins	79	0.65	0.96	0.06	-5.50
Cefalexin 250mg capsules : 17 Cefalexin 500mg capsules : 18 Cefalexin 125mg/5ml oral suspension : 3 Cefalexin 250mg/5ml oral suspension : 1 Cefalexin 500mg tablets : 2 Cefalexin 125mg/5ml oral suspension sugar free : 4 Cefalexin 250mg/5ml oral suspension sugar free : 6
Hydralazine hydrochloride☰	12	Vasodilator antihypertensive drugs	49	0.24	0.86	0.17	-3.53
Hydralazine 25mg tablets : 6 Hydralazine 50mg tablets : 6
Furosemide☰	4259	Loop diuretics	6573	0.65	0.85	0.07	-2.91
Furosemide 20mg tablets : 1555 Furosemide 40mg tablets : 2686 Furosemide 40mg/5ml oral solution sugar free : 1 Furosemide 50mg/5ml oral solution sugar free : 6 Furosemide 20mg/5ml oral solution sugar free : 11
Alcohol☰	0	Alcohols and saline	3	0.00	0.86	0.34	-2.54