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

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Quinidine sulfate☰	5	Drugs for arrhythmias	209	0.02	0.0	0.00	29.76
Quinidine sulfate 200mg tablets : 5
Other vitamin B compound preparations☰	5	Vitamin B compound	60	0.08	0.0	0.00	26.73
Vega Vitamin B Complex capsules : 5
Deflazacort☰	20	Use of corticosteroids	1362	0.01	0.0	0.00	8.91
Deflazacort 6mg tablets : 20
Other soothing haemorrhoidal preparations☰	7	Soothing haemorrhoidal preparations	44	0.16	0.0	0.02	8.60
Shark liver oil 3% / Yeast cell extract 1% ointment : 6 Preparation H ointment : 1
Propiverine hydrochloride☰	60	Drugs for urinary frequency enuresis and incontinence	1701	0.04	0.0	0.00	7.09
Propiverine 15mg tablets : 11 Propiverine 30mg modified-release capsules : 10 Propiverine 45mg modified-release capsules : 2 Detrunorm 15mg tablets : 20 Detrunorm XL 30mg capsules : 17

Prescribing where South Trafford PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Vitamin B compound☰	55	Vitamin B compound	60	0.92	1.00	0.00	-26.73
Vitamin B compound strong tablets : 55
Amitriptyline hydrochloride☰	2610	Tricyclic and related antidepressant drugs	3935	0.66	0.84	0.05	-3.30
Amitriptyline 10mg tablets : 1881 Amitriptyline 25mg tablets : 367 Amitriptyline 50mg tablets : 356 Amitriptyline 10mg/5ml oral solution sugar free : 6
Vitamin A☰	0	Vitamin A	2	0.00	0.83	0.30	-2.74
Spironolactone☰	468	Potassium-sparing diuretics and aldosterone antagonists	1012	0.46	0.72	0.10	-2.71
Spironolactone 25mg tablets : 344 Spironolactone 50mg tablets : 57 Spironolactone 100mg tablets : 62 Spironolactone 12.5mg tablets : 5
Potassium citrate☰	1	Drugs used in urological pain	2	0.50	0.93	0.18	-2.38
Potassium citrate mixture : 1