Static outliers for Kings Lynn 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 Kings Lynn PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Bilastine☰	20	Antihistamines	8381	0.00	0.00	0.00	5.41
Bilastine 20mg tablets : 20
Calcitriol☰	63	Preparations for psoriasis	733	0.09	0.01	0.01	5.39
Calcitriol 3micrograms/g ointment : 5 Silkis ointment : 58
Metoprolol tartrate☰	1016	Beta-adrenoceptor blocking drugs	25534	0.04	0.01	0.01	5.16
Metoprolol 50mg tablets : 935 Metoprolol 100mg tablets : 81
Lanthanum carbonate☰	36	Phosphate binding agents	56	0.64	0.07	0.11	5.14
Lanthanum carbonate 500mg chewable tablets : 16 Lanthanum carbonate 1g chewable tablets : 14 Lanthanum carbonate 1g oral powder sachets : 2 Fosrenol 1000mg chewable tablets : 4
Econazole nitrate☰	2	Antifungal preparations	551	0.00	0.00	0.00	4.28
Pevaryl 1% cream : 2

Prescribing where Kings Lynn PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	651	Skeletal muscle relaxants	1413	0.46	0.81	0.12	-2.95
Baclofen 5mg/5ml oral solution sugar free : 51 Baclofen 10mg tablets : 600
Mercaptopurine☰	60	Antimetabolites	308	0.19	0.81	0.27	-2.25
Mercaptopurine 50mg tablets : 60
Atropine sulfate☰	6	Mydriatics and cycloplegics	21	0.29	0.75	0.22	-2.10
Atropine 1% eye drops : 3 Atropine 1% eye drops 0.5ml unit dose preservative free : 3
Apixaban☰	1957	Oral anticoagulants	13265	0.15	0.40	0.12	-2.08
Apixaban 2.5mg tablets : 788 Apixaban 5mg tablets : 1169
Mirtazapine☰	7048	Other antidepressant drugs	16866	0.42	0.56	0.07	-2.03
Mirtazapine 30mg tablets : 1989 Mirtazapine 15mg/ml oral solution sugar free : 1 Mirtazapine 30mg orodispersible tablets : 198 Mirtazapine 15mg orodispersible tablets : 236 Mirtazapine 45mg orodispersible tablets : 98 Mirtazapine 15mg tablets : 1933 Mirtazapine 45mg tablets : 2593