Static outliers for Wellingborough & District 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 Wellingborough & District PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Empagliflozin/metformin 892 Other antidiabetic drugs 10271 0.09 0.00 0.01 7.33
Formoterol fumarate 347 Selective beta(2)-agonists 14166 0.02 0.00 0.00 4.85
Bisacodyl 1433 Stimulant laxatives 3522 0.41 0.13 0.07 4.13
Safinamide 83 Dopaminergic drugs used in parkinsonism 2059 0.04 0.00 0.01 4.02
Naphazoline hydrochloride 5 Other anti-inflammatory preparations 519 0.01 0.00 0.00 3.81

Prescribing where Wellingborough & District PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Spironolactone 1271 Potassium-sparing diuretics and aldosterone antagonists 2701 0.47 0.72 0.10 -2.63
Methylprednisolone acetate 14 Local corticosteroid injections 146 0.10 0.73 0.29 -2.18
Salicylic acid 5 Preparations for warts and calluses 18 0.28 0.67 0.21 -1.86
Ranolazine 18 Other antianginal drugs 1039 0.02 0.24 0.12 -1.81
Salbutamol 11992 Selective beta(2)-agonists 14166 0.85 0.90 0.03 -1.79
Salbutamol 100micrograms/dose inhaler CFC free : 3304
Salbutamol 200micrograms/dose dry powder inhaler : 17
Salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials : 98
Salbutamol 5mg/ml nebuliser liquid : 4
Salbutamol 5mg/2.5ml nebuliser liquid unit dose vials : 92
Salbutamol 2mg/5ml oral solution sugar free : 6
Salbutamol 100micrograms/dose breath actuated inh CFC free : 329
Ventolin 200micrograms/dose Accuhaler : 58
Ventolin 100micrograms/dose Evohaler : 6766
Ventolin 2.5mg Nebules : 273
Ventolin 5mg Nebules : 60
Salamol 2.5mg/2.5ml neb liq Steri-Neb unit dose vials : 1
Salamol 100micrograms/dose inhaler CFC free (Teva) : 60
Salamol 100micrograms/dose Easi-Breathe inhaler : 194
Airomir 100micrograms/dose inhaler : 1
Airomir 100micrograms/dose Autohaler : 18
Easyhaler Salbutamol sulfate 100micrograms/dose dry pdr inh : 677
Easyhaler Salbutamol sulfate 200micrograms/dose dry pdr inh : 34