Static outliers for City South 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 City South PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Diclofenac sodium	7	Ocular diagnostic & peri-operative prepn & photodynamic tt	10	0.70	0.03	0.07	9.53
Diclofenac 0.1% eye drops 0.3ml unit dose preservative free : 3 Diclofenac 0.1% eye drops : 3 Voltarol Ophtha 0.1% eye drops 0.3ml unit dose : 1
Phenoxybenzamine hydrochloride	5	Alpha-adrenoceptor blocking drugs	1188	0.00	0.00	0.00	7.68
Phenoxybenzamine 10mg capsules : 5
Triptorelin embonate	25	Prostate cancer and gonadorelin analogues	78	0.32	0.02	0.04	7.04
Decapeptyl SR 22.5mg inj vials : 25
Methyl salicylate/levomenthol	4	Rubefacients, topical NSAIDS, capsaicin and poultice	1932	0.00	0.00	0.00	6.05
Salonpas Pain Relief Patch 105mg/31.5mg medicated plasters : 4
Nicotine bitartrate	9	Nicotine dependence	92	0.10	0.01	0.02	5.05
Nicotine bitartrate 1mg lozenges sugar free : 3 Nicotinell 1mg lozenges : 6

Prescribing where City South PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Alfentanil hydrochloride	0	Opioid analgesics	14	0.00	0.85	0.34	-2.49

Hydrocortisone acetate	11	Topical corticosteroids	2967	0.00	0.04	0.02	-2.45
Hydrocortisone acetate 1% cream : 1 Hydrocortisone acetate 1% / Fusidic acid 2% cream : 7 Fucidin H cream : 3
Trimethoprim	199	Sulfonamides and trimethoprim	281	0.71	0.87	0.07	-2.40
Trimethoprim 100mg tablets : 36 Trimethoprim 200mg tablets : 116 Trimethoprim 50mg/5ml oral suspension sugar free : 47
Methylprednisolone acetate	10	Local corticosteroid injections	161	0.06	0.73	0.29	-2.29
Depo-Medrone 40mg/1ml suspension for injection vials : 9 Depo-Medrone with Lidocaine inj 1ml vials : 1
Tacrolimus	0	Corticosteroids and other immunosuppressants	4	0.00	0.61	0.28	-2.13