Static outliers for Wolverhampton Rwt 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 Wolverhampton Rwt PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Pyrazinamide☰	1	Antituberculosis drugs	4	0.25	0.00	0.01	19.91
Pyrazinamide 500mg tablets : 1
Granisetron☰	7	Drugs used in nausea and vertigo	1954	0.00	0.00	0.00	11.27
Granisetron 3.1mg/24hours transdermal patches : 7
Shingles (H/Z)☰	41	Vaccines and antisera	135	0.30	0.01	0.04	8.11
Shingles (Herpes Zoster) vacc (live) inj 0.65ml pfs : 5 Zostavax vacc inj 0.65ml pfs : 36
Calcium gluconate☰	7	Calcium supplements	78	0.09	0.00	0.01	6.42
Calcium gluconate 1g effervescent tablets : 7
Levobunolol hydrochloride☰	32	Treatment of glaucoma	2866	0.01	0.00	0.00	5.69
Levobunolol 0.5% eye drops 0.4ml unit dose preservative free : 26 Betagan Unit Dose 0.5% eye drops 0.4ml unit dose : 6

Prescribing where Wolverhampton Rwt PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Potassium permanganate☰	2	Oxidisers and dyes	8	0.25	0.93	0.20	-3.44
Potassium permanganate 400mg tablets for cutaneous solution : 2
Gliclazide☰	1249	Sulfonylureas	1967	0.63	0.93	0.11	-2.61
Gliclazide 80mg tablets : 705 Gliclazide 30mg modified-release tablets : 37 Gliclazide 40mg tablets : 473 Gliclazide 60mg modified-release tablets : 7 Gliclazide 160mg tablets : 27
Tamsulosin hydrochloride☰	2429	Drugs for urinary retention	2934	0.83	0.92	0.04	-2.35
Tamsulosin 400microgram modified-release capsules : 2415 Tamsulosin 400microgram modified-release tablets : 9 Pamsvax XL 400microgram capsules (Actavis) : 5
Cabergoline☰	21	Bromocriptine and other dopaminergic drugs	45	0.47	0.85	0.17	-2.30
Cabergoline 500microgram tablets : 7 Dostinex 500microgram tablets : 14
Tacrolimus☰	40	Drugs affecting the immune response	72	0.56	0.80	0.11	-2.19
Tacrolimus 0.1% ointment : 19 Tacrolimus 0.03% ointment : 2 Protopic 0.1% ointment : 14 Protopic 0.03% ointment : 5