Static outliers for Care Collaborative (Redhill) 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 Collaborative (Redhill) PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Aceclofenac☰	24	Non-steroidal anti-inflammatory drugs	2169	0.01	0.00	0.00	8.43
Preservex 100mg tablets : 24
Nateglinide☰	1	Other antidiabetic drugs	3433	0.00	0.00	0.00	7.46
Nateglinide 60mg tablets : 1
Dithranol☰	6	Preparations for psoriasis	226	0.03	0.00	0.00	5.14
Dithrocream 0.1% cream : 6
Mepivacaine hydrochloride☰	43	Local anaesthetics	678	0.06	0.00	0.01	5.02
Scandonest special 2% inj 2.2ml cartridges : 33 Scandonest plain 3% solution for injection 2.2ml cartridges : 10
Lacidipine☰	924	Calcium-channel blockers	8787	0.11	0.01	0.02	5.01
Lacidipine 2mg tablets : 441 Lacidipine 4mg tablets : 475 Lacidipine 6mg tablets : 6 Motens 4mg tablets : 2

Prescribing where Care Collaborative (Redhill) PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Calcium carbonate☰	42	Calcium supplements	55	0.76	0.96	0.05	-3.97
Calcium carbonate 1.25g chewable tablets sugar free : 10 Calcium carbonate 1.5g chewable tablets sugar free : 7 Calcichew 500mg chewable tablets : 3 Calcichew Forte chewable tablets : 5 Adcal 1500mg chewable tablets : 17
Terbinafine hydrochloride☰	87	Other antifungals	94	0.93	0.99	0.02	-3.87
Terbinafine 250mg tablets : 87
Solifenacin☰	211	Drugs for urinary frequency enuresis and incontinence	1838	0.11	0.33	0.08	-2.60
Solifenacin 5mg tablets : 131 Solifenacin 10mg tablets : 69 Vesicare 5mg tablets : 11
Baclofen☰	204	Skeletal muscle relaxants	394	0.52	0.81	0.12	-2.47
Baclofen 5mg/5ml oral solution sugar free : 26 Baclofen 10mg tablets : 178
Vitamin A☰	2	Vitamin A	9	0.22	0.83	0.30	-2.01
Vitamins A and D capsules BPC 1973 : 2