Static outliers for West Reading Villages 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 West Reading Villages PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ketoprofen☰	142	Non-steroidal anti-inflammatory drugs	3388	0.04	0.00	0.00	20.95
Ketoprofen 100mg modified-release capsules : 56 Ketoprofen 200mg modified-release capsules : 77 Oruvail 100 modified-release capsules : 9
Clonazepam☰	1	Drugs used in status epilepticus	19	0.05	0.00	0.01	8.88
Clonazepam 1mg/1ml inj ampoules and diluent : 1
Measles, mumps and rubella vaccine☰	1	Vaccines and antisera	30	0.03	0.00	0.00	8.61
Priorix vacc inj 0.5ml pre-filled syringes : 1
Trandolapril☰	243	Angiotensin-converting enzyme inhibitors	17881	0.01	0.00	0.00	6.60
Trandolapril 1mg capsules : 12 Trandolapril 2mg capsules : 27 Trandolapril 4mg capsules : 204
Hepatitis A/hepatitis B☰	4	Vaccines and antisera	30	0.13	0.01	0.02	5.39
Twinrix Adult vacc inj 1ml pre-filled syringes : 2 Ambirix vacc inj 1ml pre-filled syringes : 2

Prescribing where West Reading Villages PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Amlodipine☰	8355	Calcium-channel blockers	18742	0.45	0.75	0.08	-3.65
Amlodipine 5mg tablets : 4326 Amlodipine 10mg tablets : 3358 Amlodipine 2.5mg tablets : 34 Istin 5mg tablets : 433 Istin 10mg tablets : 204
Doxycycline hyclate☰	539	Tetracyclines	1466	0.37	0.63	0.09	-2.91
Doxycycline 50mg capsules : 12 Doxycycline 100mg capsules : 524 Doxycycline 100mg dispersible tablets sugar free : 3
Clopidogrel☰	2179	Antiplatelet drugs	9988	0.22	0.32	0.04	-2.45
Clopidogrel 75mg tablets : 2179
Coal tar☰	62	Shampoos and some other scalp preparations	260	0.24	0.40	0.09	-1.90
Coal tar extract 2% shampoo : 3 Psoriderm scalp lotion : 2 Alphosyl 2 in 1 shampoo : 5 Polytar Scalp shampoo : 4 Capasal Therapeutic shampoo : 48
Sodium picosulfate☰	0	Bowel cleansing preparations	1	0.00	0.69	0.37	-1.87