Static outliers for Care Enterprise 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 Care Enterprise PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Fenofibrate/simvastatin☰	1	Lipid-regulating drugs	21504	0.00	0.00	0.00	8.59
Fenofibrate 145mg / Simvastatin 20mg tablets : 1
Betaxolol☰	27	Treatment of glaucoma	1703	0.02	0.00	0.00	5.67
Betaxolol 0.5% eye drops : 14 Betaxolol 0.25% eye drops : 6 Betoptic 0.5% eye drops : 7
Griseofulvin☰	9	Other antifungals	87	0.10	0.01	0.02	5.54
Griseofulvin 125mg tablets : 6 Griseofulvin 500mg tablets : 3
Saxagliptin☰	460	Other antidiabetic drugs	4353	0.11	0.01	0.02	5.21
Saxagliptin 5mg tablets : 413 Saxagliptin 2.5mg tablets : 47
Diphenhydramine hydrochloride☰	71	Antihistamines	4477	0.02	0.00	0.00	4.32
Diphenhydramine 25mg tablets : 43 Diphenhydramine 50mg tablets : 22 Nytol One-A-Night 50mg tablets : 6

Prescribing where Care Enterprise PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Terbinafine hydrochloride☰	78	Other antifungals	87	0.90	0.99	0.02	-5.54
Terbinafine 250mg tablets : 78
Budesonide☰	3	Corticosteroids	15	0.20	0.72	0.18	-2.82
Budenofalk 3mg gastro-resistant capsules : 3
Vitamin A☰	0	Vitamin A	2	0.00	0.83	0.30	-2.74
Other multivitamin preparations☰	391	Multivitamin preparations	871	0.45	0.80	0.14	-2.51
Dalivit oral drops : 27 Ketovite tablets : 11 Forceval capsules : 156 Abidec Multivitamin drops : 32 Valupak Multivitamin One A Day tablets : 99 Forceval Soluble tablets : 36 Renavit tablets : 5 Paravit-cf liquid : 10 Paravit-cf capsules : 15
Prucalopride☰	24	Other drugs used in constipation	93	0.26	0.73	0.19	-2.50
Prucalopride 1mg tablets : 14 Prucalopride 2mg tablets : 10