Static outliers for Burnley East 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 Burnley East PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Chlorhexidine acetate☰	1	Chlorhexidine salts	128	0.01	0.00	0.00	8.06
Chlorhexidine acetate 0.05% irrig soln 1litre bottles : 1
Dorzolamide☰	501	Treatment of glaucoma	4037	0.12	0.04	0.02	4.63
Dorzolamide 20mg/ml eye drops : 431 Dorzolamide 20mg/ml eye drops 0.2ml unit dose preserv free : 38 Dorzolamide 20mg/ml eye drops preservative free : 21 Trusopt 20mg/ml eye drops : 11
Hepatitis A/hepatitis B☰	19	Vaccines and antisera	165	0.12	0.01	0.02	4.59
Ambirix vacc inj 1ml pre-filled syringes : 19
Tetracaine☰	92	Local anaesthetics	543	0.17	0.02	0.03	4.58
Tetracaine 4% gel : 29 Ametop 4% gel : 61 Ametop 4% gel dispensing pack : 2
Cefaclor☰	9	Cephalosporins	143	0.06	0.01	0.01	4.26
Distaclor 125mg/5ml oral suspension : 9

Prescribing where Burnley East PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Chlorhexidine gluconate☰	127	Chlorhexidine salts	128	0.99	1.00	0.00	-8.06
Chlorhexidine gluconate 4% solution : 86 HiBiScrub 4% solution : 34 Hibitane Obstetric 1% cream : 1 Quinoderm facewash : 6
Ciprofloxacin☰	55	Quinolones	88	0.62	0.85	0.08	-2.71
Ciprofloxacin 250mg tablets : 9 Ciprofloxacin 500mg tablets : 44 Ciprofloxacin 250mg/5ml oral suspension : 2
Nicotine☰	1	Nicotine dependence	108	0.01	0.57	0.25	-2.25
Nicotine 25mg/16hours transdermal patches : 1
Progesterone☰	21	Progestogens and progesterone receptor modulators	189	0.11	0.54	0.20	-2.08
Progesterone 200mg pessaries : 1 Progesterone 400mg pessaries : 4 Progesterone micronised 100mg capsules : 5 Utrogestan 100mg capsules : 10 Utrogestan 200mg vaginal capsules with applicators : 1
Prucalopride☰	29	Other drugs used in constipation	81	0.36	0.73	0.19	-1.98
Prucalopride 1mg tablets : 8 Prucalopride 2mg tablets : 21