Static outliers for Mayflower 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 Mayflower PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nabumetone☰	234	Non-steroidal anti-inflammatory drugs	5243	0.04	0.00	0.00	13.18
Nabumetone 500mg tablets : 234
Levofloxacin☰	107	Quinolones	193	0.55	0.05	0.06	8.90
Levofloxacin 500mg tablets : 86 Levofloxacin 250mg tablets : 21
Gluten free/low protein mixes☰	7	Foods for special diets	233	0.03	0.00	0.00	6.16
Mevalia low protein burger mix : 4 PK Foods low protein jelly mix dessert (2 flavours) : 3
Low protein grains/flours☰	5	Foods for special diets	233	0.02	0.00	0.00	5.68
Loprofin low protein rice : 5
Triptorelin acetate☰	61	Prostate cancer and gonadorelin analogues	225	0.27	0.02	0.05	5.39
Triptorelin acetate 3mg inj vials : 4 Decapeptyl SR 3mg inj vials : 57

Prescribing where Mayflower PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ciprofloxacin☰	80	Quinolones	193	0.41	0.85	0.08	-5.19
Ciprofloxacin 250mg tablets : 22 Ciprofloxacin 500mg tablets : 58
Baclofen☰	407	Skeletal muscle relaxants	748	0.54	0.81	0.12	-2.25
Baclofen 5mg/5ml oral solution sugar free : 29 Baclofen 10mg tablets : 374 Baclofen 10mg/5ml oral solution sugar free : 4
Pravastatin sodium☰	153	Lipid-regulating drugs	25290	0.01	0.03	0.01	-2.12
Pravastatin 10mg tablets : 63 Pravastatin 20mg tablets : 54 Pravastatin 40mg tablets : 36
Azathioprine☰	169	Antiproliferative immunosuppressants	280	0.60	0.80	0.10	-1.94
Azathioprine 25mg tablets : 22 Azathioprine 50mg tablets : 147
Mupirocin☰	11	Antibacterial preparations only used topically	49	0.22	0.67	0.23	-1.93
Mupirocin 2% ointment : 3 Mupirocin 2% cream : 8