Static outliers for Brentworth 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 Brentworth PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Etidronate disodium☰	1	Bisphosphonates and other drugs	2656	0.00	0.0	0.0	35.41
Calc carb 1.25g efferv tab and Disodium etidronate 400mg tab : 1
Ergotamine tartrate☰	2	Treatment of acute migraine	674	0.00	0.0	0.0	22.33
Migril tablets : 2
Asenapine☰	7	Drugs used for mania and hypomania	376	0.02	0.0	0.0	6.72
Asenapine 10mg sublingual tablets sugar free : 1 Asenapine 5mg sublingual tablets sugar free : 6
Oxycodone hydrochloride/naloxone hydrochloride☰	70	Opioid analgesics	3682	0.02	0.0	0.0	6.70
Oxycodone 10mg / Naloxone 5mg modified-release tablets : 34 Oxycodone 20mg / Naloxone 10mg modified-release tablets : 10 Oxycodone 5mg / Naloxone 2.5mg modified-release tablets : 26
Agomelatine☰	101	Other antidepressant drugs	6175	0.02	0.0	0.0	6.22
Agomelatine 25mg tablets : 101

Prescribing where Brentworth PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Spironolactone☰	841	Potassium-sparing diuretics and aldosterone antagonists	1826	0.46	0.72	0.10	-2.73
Spironolactone 25mg tablets : 687 Spironolactone 50mg tablets : 106 Spironolactone 100mg tablets : 43 Spironolactone 25mg/5ml oral suspension : 5
Hyoscine butylbromide☰	136	Antispasmodic and other drugs altering gut motility	743	0.18	0.33	0.06	-2.35
Hyoscine butylbromide 20mg/1ml inj ampoules : 1 Hyoscine butylbromide 10mg tablets : 88 Buscopan 10mg tablets : 47
Flecainide acetate☰	60	Drugs for arrhythmias	508	0.12	0.46	0.15	-2.26
Flecainide 100mg tablets : 15 Flecainide 50mg tablets : 41 Flecainide 25mg/5ml oral suspension : 4
Gabapentin☰	1063	Control of epilepsy	10419	0.10	0.23	0.06	-2.18
Gabapentin 100mg capsules : 267 Gabapentin 300mg capsules : 611 Gabapentin 400mg capsules : 50 Gabapentin 600mg tablets : 121 Gabapentin 800mg tablets : 13 Neurontin 300mg capsules : 1
Nicorandil☰	240	Other antianginal drugs	1077	0.22	0.52	0.14	-2.13
Nicorandil 10mg tablets : 186 Nicorandil 20mg tablets : 54