Static outliers for Lowestoft 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 Lowestoft PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Hydrogen peroxide 1 Otitis externa 811 0.00 0.00 0.00 35.41
Flupentixol hydrochloride 1214 Other antidepressant drugs 16857 0.07 0.01 0.01 9.60
Pridinol mesilate 50 Skeletal muscle relaxants 1729 0.03 0.00 0.00 8.89
Pericyazine 1168 Antipsychotic drugs 12013 0.10 0.00 0.02 5.72
Promethazine hydrochloride 4530 Antihistamines 9489 0.48 0.12 0.08 4.43

Prescribing where Lowestoft PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Apixaban 970 Oral anticoagulants 10873 0.09 0.40 0.12 -2.55
Quinine sulfate 1025 Antimalarials 1451 0.71 0.89 0.08 -2.41
Cetirizine hydrochloride 874 Antihistamines 9489 0.09 0.28 0.08 -2.40
Amlodipine 13373 Calcium-channel blockers 23369 0.57 0.75 0.08 -2.12
Donepezil hydrochloride 471 Drugs for dementia 1903 0.25 0.49 0.11 -2.12