Static outliers for Mewstone 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 Mewstone PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ceftazidime pentahydrate☰	1	Cephalosporins	57	0.02	0.00	0.00	14.95
Ceftazidime 1g powder for solution for injection vials : 1
Insulin human☰	3	Short-acting insulins	568	0.01	0.00	0.00	14.04
Humulin R KwikPen 500units/ml inj 3ml pre-filled pens : 3
Dipipanone hydrochloride☰	15	Opioid analgesics	6035	0.00	0.00	0.00	7.36
Dipipanone 10mg / Cyclizine 30mg tablets : 15
Levofloxacin☰	62	Quinolones	155	0.40	0.05	0.06	6.19
Levofloxacin 500mg tablets : 56 Levofloxacin 250mg tablets : 6
Levomepromazine maleate☰	48	Antipsychotic drugs	1906	0.03	0.00	0.00	5.63
Levomepromazine 25mg tablets : 48

Prescribing where Mewstone PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cefalexin☰	40	Cephalosporins	57	0.70	0.96	0.06	-4.52
Cefalexin 250mg capsules : 14 Cefalexin 500mg capsules : 13 Cefalexin 125mg/5ml oral suspension : 2 Cefalexin 250mg tablets : 9 Cefalexin 125mg/5ml oral suspension sugar free : 2
Ciprofloxacin☰	88	Quinolones	155	0.57	0.85	0.08	-3.39
Ciprofloxacin 250mg tablets : 56 Ciprofloxacin 500mg tablets : 32
Budesonide☰	8	Corticosteroids	36	0.22	0.72	0.18	-2.70
Budesonide 3mg gastro-resistant modified-release capsules : 2 Budesonide 3mg gastro-resistant capsules : 1 Budesonide 2mg foam enema : 1 Budesonide 9mg modified-release tablets : 2 Entocort CR 3mg capsules : 2
Mercaptopurine☰	6	Antimetabolites	41	0.15	0.81	0.27	-2.43
Mercaptopurine 50mg tablets : 6
Dexamethasone☰	217	Otitis externa	359	0.60	0.78	0.08	-2.29
Otomize ear spray : 217