Static outliers for Sasse Network 1 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 Sasse Network 1 PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Aminophylline☰	9	Theophylline	70	0.13	0.00	0.00	110.20
Aminophylline 250mg/10ml solution for injection ampoules : 9
Hepatitis A/hepatitis B☰	90	Vaccines and antisera	420	0.21	0.01	0.02	8.93
Twinrix Adult vacc inj 1ml pre-filled syringes : 62 Ambirix vacc inj 1ml pre-filled syringes : 28
Sodium citrate☰	1	Drugs used in urological pain	1	1.00	0.06	0.17	5.47
Sodium citrate 4g oral powder sachets : 1
Metformin hydrochloride/vildagliptin☰	101	Other antidiabetic drugs	3765	0.03	0.00	0.00	5.32
Vildagliptin 50mg / Metformin 1g tablets : 93 Vildagliptin 50mg / Metformin 850mg tablets : 8
Oxazepam☰	127	Anxiolytics	1518	0.08	0.01	0.02	4.80
Oxazepam 10mg tablets : 113 Oxazepam 15mg tablets : 14

Prescribing where Sasse Network 1 PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Potassium citrate☰	0	Drugs used in urological pain	1	0.00	0.93	0.18	-5.11
Aspirin☰	4176	Antiplatelet drugs	7571	0.55	0.65	0.04	-2.40
Aspirin 75mg dispersible tablets : 2086 Aspirin 75mg tablets : 1701 Aspirin 75mg gastro-resistant tablets : 388 Nu-Seals 75 gastro-resistant tablets : 1
Solifenacin☰	327	Drugs for urinary frequency enuresis and incontinence	2093	0.16	0.33	0.08	-2.09
Solifenacin 5mg tablets : 223 Solifenacin 10mg tablets : 96 Solifenacin 1mg/ml oral suspension sugar free : 4 Vesicare 5mg tablets : 1 Vesicare 10mg tablets : 3
Apixaban☰	1181	Oral anticoagulants	7529	0.16	0.40	0.12	-2.00
Apixaban 2.5mg tablets : 556 Apixaban 5mg tablets : 625
Vitamin A☰	2	Vitamin A	8	0.25	0.83	0.30	-1.92
Vitamins A and D capsules BPC 1973 : 2