Static outliers for Nantwich & Rural 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 Nantwich & Rural PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Urine testing reagents 169 Diabetic diagnostic and monitoring agents 1486 0.11 0.01 0.01 8.20
Flutamide 5 Prostate cancer and gonadorelin analogues 226 0.02 0.00 0.00 7.57
Calcitriol 109 Vitamin D 5830 0.02 0.00 0.00 6.87
Colistimethate sodium 10 Some other antibacterials 12 0.83 0.16 0.15 4.38
Fentanyl 521 Opioid analgesics 4607 0.11 0.04 0.02 4.00
Fentanyl 25micrograms/hour transdermal patches : 13
Fentanyl 50micrograms/hour transdermal patches : 1
Fentanyl 100micrograms/hour transdermal patches : 3
Fentanyl 12micrograms/hour transdermal patches : 27
Fentanyl 37.5microgram/hour transdermal patches : 4
Durogesic DTrans 25micrograms/hour transdermal patches : 7
Durogesic DTrans 12micrograms/hour transdermal patches : 5
Matrifen 12micrograms/hour transdermal patches : 66
Matrifen 25micrograms/hour transdermal patches : 68
Matrifen 50micrograms/hour transdermal patches : 50
Matrifen 75micrograms/hour transdermal patches : 20
Matrifen 100micrograms/hour transdermal patches : 4
Mezolar Matrix 12micrograms/hour transdermal patches : 21
Mezolar Matrix 25micrograms/hour transdermal patches : 31
Mezolar Matrix 50micrograms/hour transdermal patches : 13
Mezolar Matrix 100micrograms/hour transdermal patches : 12
Mezolar Matrix 37.5microgram/hour transdermal patches : 5
Abstral 100microgram sublingual tablets : 21
Fencino 12micrograms/hour transdermal patches : 48
Fencino 25micrograms/hour transdermal patches : 50
Fencino 50micrograms/hour transdermal patches : 35
Fencino 100micrograms/hour transdermal patches : 17

Prescribing where Nantwich & Rural PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glucose blood testing reagents 1283 Diabetic diagnostic and monitoring agents 1486 0.86 0.94 0.02 -3.56
OneTouch Select Plus testing strips : 11
FreeStyle Optium testing strips : 19
GlucoMen areo Sensor testing strips : 52
Active testing strips : 5
FreeStyle testing strips : 8
FreeStyle Lite testing strips : 18
Aviva testing strips : 31
WaveSense JAZZ testing strips : 56
WaveSense JAZZ Duo testing strips : 2
Contour testing strips : 3
CareSens N testing strips : 2
Mobile cassette : 205
GlucoRx Q testing strips : 3
GlucoRx Nexus testing strips : 448
GlucoRx HCT Glucose testing strips : 37
Omnitest 3 testing strips : 29
Omnitest 5 testing strips : 5
Contour Next testing strips : 37
TRUEyou testing strips : 59
TEE2 testing strips : 1
GluNEO testing strips : 2
Performa testing strips : 187
GlucoZen.auto testing strips : 56
palmdoc testing strips : 2
CareSens PRO testing strips : 1
Fora Advanced pro GD40 testing strips : 3
Contour Plus testing strips : 1
Sodium chloride 10 Topical nasal decongestants 92 0.11 0.54 0.18 -2.39
Aripiprazole 101 Antipsychotic drugs 2098 0.05 0.13 0.03 -2.31
Zinc sulfate monohydrate 0 Zinc 6 0.00 0.74 0.33 -2.21
Prednisolone 1222 Use of corticosteroids 1500 0.81 0.88 0.03 -2.09