Static outliers for Sudbury 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 Sudbury PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Paricalcitol	17	Vitamin D	9871	0.00	0.00	0.00	15.02
Paricalcitol 1microgram capsules : 9 Paricalcitol 2microgram capsules : 8
Saxagliptin/metformin	57	Other antidiabetic drugs	4932	0.01	0.00	0.00	6.74
Saxagliptin 2.5mg / Metformin 1g tablets : 57
Levobunolol hydrochloride	27	Treatment of glaucoma	2308	0.01	0.00	0.00	6.00
Levobunolol 0.5% eye drops 0.4ml unit dose preservative free : 16 Betagan Unit Dose 0.5% eye drops 0.4ml unit dose : 11
Etoricoxib	667	Non-steroidal anti-inflammatory drugs	2973	0.22	0.04	0.03	5.92
Etoricoxib 60mg tablets : 313 Etoricoxib 90mg tablets : 228 Etoricoxib 120mg tablets : 42 Etoricoxib 30mg tablets : 84
Voriconazole	4	Triazole antifungals	194	0.02	0.00	0.00	5.44
Voriconazole 50mg tablets : 4

Prescribing where Sudbury PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Nitrofurantoin	868	Urinary-tract infections	1083	0.80	0.96	0.05	-3.15
Nitrofurantoin 50mg capsules : 109 Nitrofurantoin 100mg capsules : 30 Nitrofurantoin 25mg/5ml oral suspension sugar free : 5 Nitrofurantoin 50mg tablets : 93 Nitrofurantoin 100mg tablets : 7 Nitrofurantoin 100mg modified-release capsules : 624
Cefalexin	206	Cephalosporins	258	0.80	0.96	0.06	-2.83
Cefalexin 250mg capsules : 34 Cefalexin 500mg capsules : 107 Cefalexin 125mg/5ml oral suspension : 2 Cefalexin 250mg/5ml oral suspension : 10 Cefalexin 250mg tablets : 34 Cefalexin 500mg tablets : 8 Cefalexin 250mg/5ml oral suspension sugar free : 11
Tacrolimus	16	Drugs affecting the immune response	32	0.50	0.80	0.11	-2.68
Tacrolimus 0.1% ointment : 12 Tacrolimus 0.03% ointment : 1 Protopic 0.1% ointment : 3
Clotrimazole	49	Antifungal preparations	234	0.21	0.43	0.11	-1.99
Clotrimazole 1% solution : 3 Clotrimazole 1% cream : 45 Clotrimazole 1% spray : 1
Procyclidine hydrochloride	227	Antimuscarinic drugs used in parkinsonism	353	0.64	0.85	0.11	-1.94
Procyclidine 5mg tablets : 55 Kemadrin 5mg tablets : 172