Static outliers for Gosport Central 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 Gosport Central PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Propamidine isetionate☰	3	Antibacterials	171	0.02	0.00	0.00	5.86
Golden Eye 0.1% drops : 3
Sodium fusidate☰	28	Antibacterial preparations also used systemically	161	0.17	0.02	0.03	5.49
Sodium fusidate 2% ointment : 15 Fucidin 20mg/g ointment : 13
Salicylic acid☰	1	Drugs for oral ulceration and inflammation	78	0.01	0.00	0.00	5.25
Pyralvex solution : 1
Quinapril hydrochloride with diuretic☰	3	Angiotensin-converting enzyme inhibitors	11088	0.00	0.00	0.00	5.23
Quinapril 10mg / Hydrochlorothiazide 12.5mg tablets : 3
Benzalkonium chloride☰	41	Shampoos and some other scalp preparations	236	0.17	0.04	0.03	4.35
Benzalkonium chloride 0.5% shampoo : 4 Dermax Therapeutic 0.5% shampoo : 37

Prescribing where Gosport Central PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Codeine phosphate☰	7	Cough suppressants	35	0.20	0.78	0.21	-2.76
Codeine 15mg/5ml linctus : 4 Codeine 15mg/5ml linctus sugar free : 3
Baclofen☰	337	Skeletal muscle relaxants	666	0.51	0.81	0.12	-2.57
Baclofen 5mg/5ml oral solution sugar free : 73 Baclofen 10mg tablets : 264
Other emollient preparations☰	556	Emollients	713	0.78	0.89	0.04	-2.54
White soft paraffin 95% / Liquid paraffin 5% ointment : 2 White soft paraffin 50% / Liquid paraffin 50% ointment : 13 Isopropyl myristate 15% / Liquid paraffin 15% gel : 2 White soft paraffin 15% / Liquid paraffin light 6% cream : 11 Diprobase ointment : 10 E45 cream : 31 Aveeno cream : 18 Dermol 500 lotion : 279 Doublebase gel : 49 Aveeno lotion : 7 Oilatum cream : 29 Aveeno Skin Relief moisturising lotion with shea butter : 4 Dermol cream : 78 Oilatum Junior cream : 4 Doublebase Dayleve gel : 18 Aveeno moisturising creamy oil : 1
Betamethasone valerate☰	398	Topical corticosteroids	2312	0.17	0.28	0.04	-2.46
Betamethasone valerate 0.1% cream : 46 Betamethasone valerate 0.025% cream : 18 Betamethasone valerate 0.1% ointment : 11 Betamethasone valerate 0.025% ointment : 13 Betamethasone valerate 0.1% scalp application : 71 Betamethasone 0.1% foam : 2 Betamethasone valerate 0.1% / Fusidic acid 2% cream : 60 Betnovate 0.1% cream : 11 Betnovate RD 0.025% cream : 4 Betnovate 0.1% ointment : 77 Betnovate RD 0.025% ointment : 12 Betnovate 0.1% scalp application : 10 Fucibet cream : 39 Fucibet Lipid cream : 1 Betacap 0.1% scalp application : 21 Bettamousse 0.1% cutaneous foam : 1 Xemacort 20mg/g / 1mg/g cream : 1
Fusidic acid☰	84	Antibacterial preparations also used systemically	161	0.52	0.73	0.09	-2.16
Fusidic acid 2% cream : 81 Fucidin 20mg/g cream : 3