Static outliers for South Uttlesford 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 South Uttlesford PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Benzbromarone☰	6	Gout and cytotoxic induced hyperiuicaemia	3393	0.00	0.0	0.0	6.99
Benzbromarone 100mg tablets : 6
Ketotifen fumarate☰	52	Antihistamines	6778	0.01	0.0	0.0	6.79
Ketotifen 1mg capsules : 4 Ketotifen 1mg/5ml oral solution sugar free : 18 Ketotifen 1mg tablets : 29 Zaditen 1mg tablets : 1
Loperamide hydrochloride and simeticone☰	11	Antimotility drugs	465	0.02	0.0	0.0	5.64
Loperamide 2mg / Simeticone 125mg tablets : 3 Imodium Plus Comfort tablets : 8
Vildagliptin☰	109	Other antidiabetic drugs	4383	0.02	0.0	0.0	5.63
Vildagliptin 50mg tablets : 109
Bempedoic acid/Ezetimibe☰	6	Lipid-regulating drugs	37684	0.00	0.0	0.0	5.51
Nustendi 180mg/10mg tablets : 6

Prescribing where South Uttlesford PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Loperamide hydrochloride☰	452	Antimotility drugs	465	0.97	1.00	0.01	-4.70
Loperamide 2mg capsules : 402 Loperamide 1mg/5ml oral solution sugar free : 27 Loperamide 2mg tablets : 10 Imodium 1mg/5ml oral solution : 12 Imodium Instant Melts 2mg orodispersible tablets : 1
Dexamethasone☰	404	Otitis externa	660	0.61	0.78	0.08	-2.19
Otomize ear spray : 404
Zinc oxide☰	6	Barrier preparations	443	0.01	0.51	0.24	-2.10
Sudocrem antiseptic healing cream : 6
Amiodarone hydrochloride☰	88	Drugs for arrhythmias	520	0.17	0.48	0.15	-2.05
Amiodarone 100mg tablets : 25 Amiodarone 200mg tablets : 63
Pizotifen malate☰	83	Prophylaxis of migraine	210	0.40	0.65	0.13	-1.96
Pizotifen 500microgram tablets : 59 Pizotifen 1.5mg tablets : 24