Static outliers for Eden (Cumbria) 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 Eden (Cumbria) PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Patiromer calcium	6	Oral potassium	20	0.30	0.01	0.03	10.45
Patiromer calcium 8.4g oral powder sachets : 6
Perphenazine	8	Antipsychotic drugs	3799	0.00	0.00	0.00	9.93
Perphenazine 2mg tablets : 8
Torasemide	120	Loop diuretics	5745	0.02	0.00	0.00	8.31
Torasemide 2.5mg tablets : 38 Torasemide 5mg tablets : 55 Torasemide 10mg tablets : 27
Other osmotic laxative preparations	1	Osmotic laxatives	3040	0.00	0.00	0.00	6.66
Plenvu oral powder sachets : 1
Alverine citrate/simeticone	3	Antispasmodic and other drugs altering gut motility	1322	0.00	0.00	0.00	4.76
Alverine 60mg / Simeticone 300mg capsules : 3

Prescribing where Eden (Cumbria) PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Potassium chloride	14	Oral potassium	20	0.70	0.98	0.06	-4.46
Sando-K effervescent tablets : 14
Ramipril	8351	Angiotensin-converting enzyme inhibitors	21955	0.38	0.69	0.14	-2.29
Ramipril 1.25mg capsules : 1404 Ramipril 2.5mg capsules : 2369 Ramipril 5mg capsules : 2084 Ramipril 10mg capsules : 2398 Ramipril 1.25mg tablets : 28 Ramipril 2.5mg tablets : 45 Ramipril 5mg tablets : 10 Ramipril 10mg tablets : 10 Ramipril 2.5mg/5ml oral solution sugar free : 3
Senna	1122	Stimulant laxatives	3229	0.35	0.56	0.11	-1.98
Senna 7.5mg tablets : 1062 Senna fruit 12.4% / Ispaghula 54.2% granules : 5 Senna 15mg tablets : 18 Senna 7.5mg/5ml oral solution sugar free : 34 Senokot Max Strength tablet 12 Years Plus : 1 Senokot Max Strength tablets Adult : 2
Co-amilofruse (Amiloride hydrochloride/frusemide)	18	Potassium sparing diuretics and compounds	53	0.34	0.70	0.19	-1.90
Co-amilofruse 5mg/40mg tablets : 7 Co-amilofruse 2.5mg/20mg tablets : 11
Mercaptopurine	33	Antimetabolites	113	0.29	0.81	0.27	-1.90
Mercaptopurine 50mg tablets : 33