Static outliers for Barnet 3 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 Barnet 3 PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cefotaxime sodium 1 Cephalosporins 727 0.00 0.00 0.00 9.48
Testosterone propionate 1 Male sex hormones and antagonists 2943 0.00 0.00 0.00 6.07
Felbinac 12 Rubefacients, topical NSAIDS, capsaicin and poultice 4373 0.00 0.00 0.00 5.56
Low protein cooking aids 13 Foods for special diets 884 0.01 0.00 0.00 5.28
Isosorbide dinitrate 233 Nitrates 3113 0.07 0.01 0.01 4.61

Prescribing where Barnet 3 PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Beclometasone dipropionate 3788 Corticosteroids (respiratory) 9805 0.39 0.56 0.10 -1.84
Beclometasone 50micrograms/dose inhaler CFC free : 49
Beclometasone 100micrograms/dose inhaler CFC free : 236
Beclometasone 100mcg/dose breath actuated inhaler CFC free : 13
Beclometasone 200micrograms/dose dry powder inhaler : 1
Beclometasone 200micrograms/dose inhaler CFC free : 2
Beclometasone 100microg/Formoterol 6microg/dose inh CFCfree : 42
Beclometasone 100microg/Formoterol 6microg/dose dry pdr inh : 34
Beclometasone 200microg/Formoterol 6microg/dose inh CFC free : 24
Beclometasone 200microg/Formoterol 6microg/dose dry pdr inh : 14
Qvar 50 inhaler : 54
Qvar 100 inhaler : 105
Qvar 50 Autohaler : 21
Qvar 100 Autohaler : 65
Qvar 50micrograms/dose Easi-Breathe inhaler : 16
Qvar 100micrograms/dose Easi-Breathe inhaler : 31
Easyhaler Beclometasone 200micrograms/dose dry pdr inhaler : 7
Clenil Modulite 50micrograms/dose inhaler : 272
Clenil Modulite 100micrograms/dose inhaler : 1661
Clenil Modulite 200micrograms/dose inhaler : 355
Clenil Modulite 250micrograms/dose inhaler : 37
Fostair 100micrograms/dose / 6micrograms/dose inhaler : 473
Fostair 200micrograms/dose / 6micrograms/dose inhaler : 165
Fostair NEXThaler 100microg/dose / 6microg/dose dry pdr inh : 63
Fostair NEXThaler 200microg/dose / 6microg/dose dry pdr inh : 39
Soprobec 50micrograms/dose inhaler : 1
Soprobec 200micrograms/dose inhaler : 3
Soprobec 100micrograms/dose inhaler : 5
Naftidrofuryl oxalate 16 Peripheral vasodilators and related drugs 79 0.20 0.67 0.28 -1.66
Duloxetine hydrochloride 676 Other antidepressant drugs 9449 0.07 0.15 0.05 -1.57
Quetiapine 1796 Antipsychotic drugs 7786 0.23 0.36 0.08 -1.53
Morphine sulfate 1091 Opioid analgesics 8468 0.13 0.21 0.06 -1.50
Morphine sulfate 1mg/1ml solution for injection ampoules : 1
Morphine sulfate 20mg/ml oral solution sugar free : 4
Morphine sulfate 10mg/1ml solution for injection ampoules : 62
Morphine 100mg modified-release tablets : 10
Morphine 60mg modified-release tablets : 29
Morphine 10mg modified-release tablets : 149
Morphine 30mg modified-release tablets : 79
Morphine 10mg tablets : 16
Morphine 20mg tablets : 1
Morphine 15mg modified-release tablets : 47
Morphine 5mg modified-release tablets : 91
Morphine sulfate 10mg/5ml oral solution : 252
Morphine 90mg modified-release capsules : 5
Morphine 150mg modified-release capsules : 2
Morphine 10mg modified-release capsules : 30
Morphine 30mg modified-release capsules : 15
Morphine 60mg modified-release capsules : 7
Morphine sulfate 10mg/10ml solution for injection ampoules : 3
MST Continus 10mg tablets : 2
MST Continus 30mg tablets : 16
MST Continus 60mg tablets : 21
MST Continus 100mg tablets : 12
MST Continus 200mg tablets : 5
Oramorph 20mg/ml concentrated oral solution : 4
Oramorph 10mg/5ml oral solution : 193
Sevredol 10mg tablets : 12
Sevredol 50mg tablets : 5
Zomorph 60mg modified-release capsules : 3
Morphgesic SR 30mg tablets : 15