Static outliers for Liverpool First 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 Liverpool First PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Bupivacaine hydrochloride 569 Local anaesthetics 878 0.65 0.01 0.04 17.91
Benzydamine hydrochloride 14 Rubefacients, topical NSAIDS, capsaicin and poultice 2730 0.01 0.00 0.00 9.69
Dithranol 13 Preparations for psoriasis 408 0.03 0.00 0.00 6.29
Diphenhydramine hydrochloride 98 Antihistamines 4524 0.02 0.00 0.00 6.09
Haloperidol decanoate 5 Antipsychotic depot injections 5 1.00 0.09 0.18 5.21

Prescribing where Liverpool First PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Lidocaine hydrochloride 288 Local anaesthetics 878 0.33 0.91 0.07 -8.09
Macrogol 3350 1439 Osmotic laxatives 2792 0.52 0.72 0.07 -2.86
Macrogol compound oral powder sachets NPF sugar free : 300
Macrogol compound half-strength oral pdr sach NPF sugar free : 3
Macrogol 3350 oral powder 8.5g sachets sugar free : 1
Movicol oral powder 13.8g sachets lemon & lime : 62
Movicol-Half oral powder 6.9g sachets : 2
Movicol Plain oral powder 13.7g sachets : 56
Movicol Paediatric Plain oral powder 6.9g sachets : 110
Movicol Paediatric Chocolate oral powder 6.9g sachets : 11
Laxido Orange oral powder sachets sugar free : 456
Laxido Paediatric Plain oral powder 6.9g sachets : 6
CosmoCol Orange Lemon and Lime oral powder sachets : 43
CosmoCol Orange Flavour oral powder sachets : 153
CosmoCol Lemon and Lime Flavour oral powder sachets : 56
CosmoCol Paediatric oral powder 6.9g sachets : 47
CosmoCol Half oral powder 6.9g sachets : 6
CosmoCol Plain oral powder sachets : 127
Codeine phosphate 36 Cough suppressants 122 0.30 0.78 0.21 -2.30
Co-amoxiclav (Amoxicillin/clavulanic acid) 115 Broad-spectrum penicillins 2508 0.05 0.20 0.07 -2.26
Glucose blood testing reagents 1661 Diabetic diagnostic and monitoring agents 1856 0.89 0.94 0.02 -2.17