Static outliers for Stone & Eccleshall 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 Stone & Eccleshall PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Paracetamol and ibuprofen☰	3	Non-opioid analgesics and compound preparations	8514	0.00	0.00	0.00	9.41
Paracetamol 500mg / Ibuprofen 200mg tablets : 3
Rabeprazole sodium☰	662	Proton pump inhibitors	18730	0.04	0.00	0.00	7.09
Rabeprazole 10mg gastro-resistant tablets : 162 Rabeprazole 20mg gastro-resistant tablets : 486 Pariet 20mg gastro-resistant tablets : 14
Ibuprofen lysine☰	14	Non-steroidal anti-inflammatory drugs	2846	0.00	0.00	0.00	6.25
Ibuprofen lysine 400mg tablets : 14
Olmesartan medoxomil☰	940	Angiotensin-II receptor antagonists	6720	0.14	0.02	0.02	5.19
Olmesartan medoxomil 10mg tablets : 175 Olmesartan medoxomil 20mg tablets : 511 Olmesartan medoxomil 40mg tablets : 254
Apomorphine hydrochloride☰	34	Dopaminergic drugs used in parkinsonism	1412	0.02	0.00	0.00	5.04
Apomorphine 50mg/10ml inf pre-filled syringes : 8 APO-go PEN 30mg/3ml solution for injection : 13 APO-go PFS 50mg/10ml inf pre-filled syringes : 13

Prescribing where Stone & Eccleshall PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbocisteine☰	562	Mucolytics	734	0.77	0.97	0.08	-2.69
Carbocisteine 375mg capsules : 506 Carbocisteine 250mg/5ml oral solution : 20 Carbocisteine 750mg/10ml soln 10ml sachets sugar free : 30 Carbocisteine 750mg/5ml oral solution sugar free : 3 Mucodyne 250mg/5ml syrup : 3
Urea hydrogen peroxide☰	1	Removal of ear wax and other substances	4	0.25	0.83	0.26	-2.25
Urea hydrogen peroxide 5% ear drops : 1
Letrozole☰	73	Breast cancer	829	0.09	0.43	0.18	-1.93
Letrozole 2.5mg tablets : 73
Fluconazole☰	82	Triazole antifungals	113	0.73	0.85	0.07	-1.81
Fluconazole 50mg capsules : 38 Fluconazole 150mg capsules : 43 Fluconazole 50mg/5ml oral suspension : 1
Tacrolimus☰	2	Corticosteroids and other immunosuppressants	19	0.11	0.61	0.28	-1.76
Prograf 1mg capsules : 2