Static outliers for Coventry North 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 Coventry North PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Proguanil hydrochloride☰	1	Antimalarials	1404	0.00	0.00	0.00	42.54
Proguanil 100mg tablets : 1
Sodium dihydrogen phosphate dihydrate☰	4	Phosphate supplements	5	0.80	0.00	0.04	17.82
Sodium dihydrogen phosphate dihydrate 780mg/5ml soln : 4
Glutaraldehyde☰	9	Preparations for warts and calluses	36	0.25	0.01	0.03	8.29
Glutaraldehyde 10% solution : 7 Glutarol 10% cutaneous solution : 2
Ergocalciferol☰	237	Vitamin D	9124	0.03	0.00	0.00	7.44
Calcium and Ergocalciferol tablets : 222 Ergocalciferol 12.5microgram tablets : 5 Colecalciferol 800unit / Calcium carbonate 1.25g chew tab : 9 Ergocalciferol 3,000units/ml oral solution : 1
Fluocinonide☰	43	Topical corticosteroids	3932	0.01	0.00	0.00	6.96
Fluocinonide 0.05% cream : 2 Fluocinonide 0.05% ointment : 7 Metosyn FAPG 0.05% cream : 6 Metosyn 0.05% ointment : 28

Prescribing where Coventry North PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ursodeoxycholic acid☰	108	Drugs affecting biliary composition and flow	113	0.96	1.00	0.00	-35.41
Ursodeoxycholic acid 150mg tablets : 1 Ursodeoxycholic acid 250mg capsules : 55 Ursodeoxycholic acid 250mg/5ml oral suspension sugar free : 10 Ursodeoxycholic acid 500mg tablets : 36 Ursodeoxycholic acid 250mg tablets : 6
Other phosphate supplement preparations☰	1	Phosphate supplements	5	0.20	1.00	0.04	-17.82
Phosphate Sandoz effervescent tablets : 1
Entecavir☰	0	Chronic hepatitis B	2	0.00	0.94	0.23	-4.13
Alcohol☰	0	Alcohols and saline	1	0.00	0.86	0.34	-2.54
Vitamin E☰	0	Vitamin E	1	0.00	0.73	0.33	-2.24