Static outliers for East Suffolk 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 East Suffolk PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydrocort sodiumphos 140 Antibacterials 1060 0.13 0.01 0.02 5.97
Eprosartan 383 Angiotensin-II receptor antagonists 24300 0.02 0.00 0.00 4.02
Saxagliptin/dapagliflozin 112 Other antidiabetic drugs 13153 0.01 0.00 0.00 3.89
Etodolac 509 Non-steroidal anti-inflammatory drugs 9965 0.05 0.01 0.01 3.79
Diclofenac sod 1 Mouth-washes, gargles and dentifrices 98 0.01 0.00 0.00 3.16

Prescribing where East Suffolk PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tiotropium bromide 1185 Antimuscarinic bronchodilators 3980 0.30 0.71 0.15 -2.78
Tramadol hydrochloride 4411 Opioid analgesics 29392 0.15 0.26 0.06 -1.94
Tramadol 50mg capsules : 3428
Tramadol 100mg modified-release tablets : 18
Tramadol 150mg modified-release tablets : 1
Tramadol 200mg modified-release tablets : 4
Tramadol 50mg soluble tablets sugar free : 5
Tramadol 50mg modified-release capsules : 15
Tramadol 100mg modified-release capsules : 35
Tramadol 150mg modified-release capsules : 25
Tramadol 200mg modified-release capsules : 18
Tramadol 400mg modified-release tablets : 7
Tramadol 50mg orodispersible tablets sugar free : 6
Tramadol 37.5mg / Paracetamol 325mg tablets : 44
Tramadol 50mg modified-release tablets : 250
Zydol SR 100mg tablets : 3
Zydol SR 200mg tablets : 6
Zydol SR 50mg tablets : 11
Zamadol SR 100mg capsules : 9
Zamadol SR 200mg capsules : 5
Mabron 100mg modified-release tablets (Teva) : 9
Tramulief SR 100mg tablets : 10
Marol 200mg modified-release tablets (Teva) : 121
Marol 150mg modified-release tablets (Teva) : 72
Marol 100mg modified-release tablets (Teva) : 306
Maxitram SR 50mg capsules : 3
Cefalexin 857 Cephalosporins 1008 0.85 0.96 0.06 -1.93
Zinc oxide 79 Barrier preparations 730 0.11 0.51 0.24 -1.70
Ibuprofen 457 Non-steroidal anti-inflammatory drugs 9965 0.05 0.11 0.04 -1.64