Static outliers for Southend Victoria 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 Southend Victoria PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Ibuprofen sodium dihydrate	3	Non-steroidal anti-inflammatory drugs	2734	0.00	0.00	0.00	20.18
Ibuprofen sodium dihydrate 400mg tablets : 3
Perindopril arginine with diuretic	182	Angiotensin-converting enzyme inhibitors	14317	0.01	0.00	0.00	9.38
Perindopril arginine 5mg / Indapamide 1.25mg tablets : 161 Coversyl Arginine Plus 5mg/1.25mg tablets : 21
Paracetamol combined preparations	40	Non-opioid analgesics and compound preparations	13550	0.00	0.00	0.00	6.63
Solpadeine Plus tablets : 5 Solpadeine Plus soluble tablets : 8 Solpadeine Max soluble tablets : 27
Lidocaine	35	Local anaesthetics	103	0.34	0.06	0.05	5.58
Lidocaine 5% ointment : 33 Lidocaine 4% cream : 2
Magnesium carbonate	5	Antacids and simeticone	22	0.23	0.00	0.04	5.40
Magnesium carbonate heavy 500mg capsules : 5

Prescribing where Southend Victoria PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Lidocaine hydrochloride	64	Local anaesthetics	103	0.62	0.91	0.07	-4.05
Lidocaine 2% and Chlorhexidine gel : 1 Lidocaine 2.5% / Prilocaine 2.5% cream : 1 Lidocaine 5% medicated plasters : 25 Instillagel gel : 7 Emla 5% cream : 20 Versatis 700mg medicated plasters : 7 Ralvo 700mg medicated plasters : 3
Moxonidine	18	Centrally-acting antihypertensive drugs	125	0.14	0.67	0.20	-2.68
Moxonidine 200microgram tablets : 3 Moxonidine 400microgram tablets : 7 Moxonidine 300microgram tablets : 8
Potassium permanganate	1	Oxidisers and dyes	2	0.50	0.93	0.20	-2.19
Potassium permanganate 400mg tablets for cutaneous solution : 1
Rifampicin	0	Antituberculosis drugs	4	0.00	0.74	0.35	-2.12

Clobetasone butyrate	262	Topical corticosteroids	3731	0.07	0.13	0.03	-2.00
Clobetasone 0.05% cream : 65 Clobetasone 0.05% ointment : 68 Clobet 0.05%/Oxytetracycline 3% /Nystatin 100,000units/g crm : 10 Eumovate 0.05% cream : 30 Eumovate 0.05% ointment : 43 Trimovate cream : 46