Static outliers for North Devon Coastal 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 North Devon Coastal PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Camellia sinensis extract 5 Preparations for warts and calluses 42 0.12 0.00 0.01 18.24
Triptorelin embonate 79 Prostate cancer and gonadorelin analogues 304 0.26 0.02 0.04 5.62
Nebivolol 977 Beta-adrenoceptor blocking drugs 13804 0.07 0.02 0.01 4.25
Darifenacin hydrobromide 279 Drugs for urinary frequency enuresis and incontinence 2230 0.13 0.01 0.03 4.23
Diltiazem hydrochloride 2024 Calcium-channel blockers 15511 0.13 0.05 0.02 4.11
Diltiazem 60mg modified-release tablets : 1
Diltiazem 300mg modified-release capsules : 6
Diltiazem 120mg modified-release tablets : 5
Diltiazem 240mg modified-release capsules : 6
Tildiem 60mg modified-release tablets : 98
Tildiem Retard 90mg tablets : 10
Tildiem Retard 120mg tablets : 18
Tildiem LA 300 capsules : 40
Tildiem LA 200 capsules : 44
Adizem-SR 90mg capsules : 25
Adizem-SR 120mg capsules : 27
Adizem-SR 180mg capsules : 4
Adizem-XL 300mg capsules : 245
Adizem-XL 120mg capsules : 509
Adizem-XL 180mg capsules : 411
Adizem-XL 240mg capsules : 421
Adizem-XL 200mg capsules : 11
Slozem 180mg capsules : 4
Angitil SR 120 capsules : 5
Zemtard 300 XL capsules : 13
Zemtard 120 XL capsules : 55
Zemtard 180 XL capsules : 28
Zemtard 240 XL capsules : 17
Viazem XL 120mg capsules : 2
Viazem XL 180mg capsules : 13
Viazem XL 360mg capsules : 6

Prescribing where North Devon Coastal PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Atropine sulfate 0 Mydriatics and cycloplegics 1 0.00 0.75 0.22 -3.39
Senna 653 Stimulant laxatives 2794 0.23 0.56 0.11 -3.04
Vitamin E 0 Vitamin E 5 0.00 0.73 0.33 -2.24
Glycopyrronium bromide 0 Antimuscarinic drugs 121 0.00 0.78 0.37 -2.11
Fexofenadine hydrochloride 882 Antihistamines 5093 0.17 0.36 0.09 -2.06