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

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Podophyllotoxin☰	1	Preparations for warts and calluses	1	1.00	0.06	0.07	13.27
Podophyllotoxin 0.15% cream : 1
Carvedilol☰	383	Beta-adrenoceptor blocking drugs	3317	0.12	0.01	0.01	11.25
Carvedilol 12.5mg tablets : 237 Carvedilol 25mg tablets : 87 Carvedilol 3.125mg tablets : 26 Carvedilol 6.25mg tablets : 33
Ketamine hydrochloride☰	6	Drugs used in nausea and vertigo	700	0.01	0.00	0.00	10.33
Ketamine 25mg/5ml oral solution : 6
Colestipol hydrochloride☰	7	Lipid-regulating drugs	6453	0.00	0.00	0.00	7.76
Colestipol 5g granules sachets sugar free : 2 Colestid 5g granules sachets plain : 5
Eletriptan☰	25	Treatment of acute migraine	332	0.08	0.01	0.01	7.55
Eletriptan 20mg tablets : 8 Eletriptan 40mg tablets : 17

Prescribing where Central Telford PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbimazole☰	18	Antithyroid drugs	29	0.62	0.93	0.04	-6.97
Carbimazole 5mg tablets : 10 Carbimazole 20mg tablets : 3 Carbimazole 10mg tablets : 5
Fusidic acid☰	24	Antibacterial preparations also used systemically	57	0.42	0.73	0.09	-3.23
Fusidic acid 2% cream : 24
Salicylic acid☰	0	Preparations for warts and calluses	1	0.00	0.67	0.21	-3.17
Bisoprolol fumarate☰	1629	Beta-adrenoceptor blocking drugs	3317	0.49	0.65	0.06	-2.91
Bisoprolol 5mg tablets : 358 Bisoprolol 10mg tablets : 193 Bisoprolol 2.5mg tablets : 637 Bisoprolol 3.75mg tablets : 31 Bisoprolol 7.5mg tablets : 82 Bisoprolol 1.25mg tablets : 328
Prucalopride☰	2	Other drugs used in constipation	11	0.18	0.73	0.19	-2.90
Prucalopride 2mg tablets : 2