Static outliers for Cheadle Network 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 Cheadle Network PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pimozide 23 Antipsychotic drugs 2054 0.01 0.00 0.00 10.11
Chloroquine phosphate 5 Antimalarials 427 0.01 0.00 0.00 5.97
Azilsartan medoxomil 5 Angiotensin-II receptor antagonists 4978 0.00 0.00 0.00 5.38
Other topical nasal decongestant preparations 1 Topical nasal decongestants 58 0.02 0.00 0.00 5.36
Darifenacin hydrobromide 261 Drugs for urinary frequency enuresis and incontinence 2221 0.12 0.01 0.03 3.94

Prescribing where Cheadle Network PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Spironolactone 687 Potassium-sparing diuretics and aldosterone antagonists 1294 0.53 0.72 0.10 -1.99
Mupirocin 4 Antibacterial preparations only used topically 19 0.21 0.67 0.23 -1.99
Other food for special diet preparations 198 Foods for special diets 645 0.31 0.64 0.17 -1.92
Instant Carobel powder : 4
MCT oil : 5
Nutriprem 2 powder : 13
Vitajoule powder : 1
Fortijuce liquid (7 flavours) : 29
Calogen emulsion neutral : 15
Maxijul Super Soluble powder 132g sachets : 5
Calogen emulsion strawberry : 11
FlavourPac oral powder 4g sachets blackcurrant : 7
HCU express15 oral powder 25g sachets : 7
Fortijuce Starter Pack liquid : 8
Nutramigen PurAmino powder : 7
Neocate LCP powder : 32
Glycosade oral powder 60g sachets unflavoured : 1
Calogen Extra emulsion (2 flavours) : 1
DocOmega oral powder 4g sachets : 6
ProZero liquid : 3
S.O.S20 oral powder 42g sachets : 1
FruitiVits oral powder 6g sachets : 4
Calogen Extra Shots emulsion (2 flavours) : 1
ProSource jelly (4 flavours) : 1
Nutramigen 1 with LGG powder : 16
Nutramigen 2 with LGG powder : 4
Vital 1.5kcal liquid (3 flavours) : 10
YoguMaxx low protein instant powder : 1
EleCare powder : 4
Glycosade oral powder 60g sachets lemon : 1
Solifenacin 381 Drugs for urinary frequency enuresis and incontinence 2221 0.17 0.33 0.08 -1.91
Nicorandil 285 Other antianginal drugs 1062 0.27 0.52 0.14 -1.81