Static outliers for Rochdale North 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 Rochdale North PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Benzyl benzoate☰	2	Parasiticidal preparations	53	0.04	0.0	0.00	23.64
Benzyl benzoate 25% application : 2
Perphenazine☰	19	Antipsychotic drugs	5120	0.00	0.0	0.00	17.58
Perphenazine 2mg tablets : 19
Meningococcal A + C + W135 + Y vaccine☰	18	Vaccines and antisera	217	0.08	0.0	0.01	9.94
Nimenrix vacc inj 0.5ml pre-filled syringes : 18
Tolcapone☰	6	Dopaminergic drugs used in parkinsonism	1513	0.00	0.0	0.00	7.70
Tolcapone 100mg tablets : 6
Glycopyrronium/formoterol☰	11	Compound bronchodilator preparations	407	0.03	0.0	0.00	7.39
Bevespi Aerosphere 7.2microg / 5microg/dose pressurised inh : 11

Prescribing where Rochdale North PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Warfarin sodium☰	46	Oral anticoagulants	3981	0.01	0.24	0.09	-2.70
Warfarin 1mg tablets : 23 Warfarin 3mg tablets : 13 Warfarin 5mg tablets : 5 Warfarin 500microgram tablets : 5
Hydralazine hydrochloride☰	18	Vasodilator antihypertensive drugs	43	0.42	0.86	0.17	-2.53
Hydralazine 25mg tablets : 14 Hydralazine 50mg tablets : 4
Folic acid☰	2028	Drugs used in megaloblastic anaemias	5473	0.37	0.68	0.13	-2.36
Folic acid 5mg tablets : 1918 Folic acid 400microgram tablets : 50 Folic acid 2.5mg/5ml oral solution sugar free : 60
Baclofen☰	235	Skeletal muscle relaxants	430	0.55	0.81	0.12	-2.23
Baclofen 5mg/5ml oral solution sugar free : 73 Baclofen 10mg tablets : 154 Lyflex 5mg/5ml oral solution : 8
Nicorandil☰	258	Other antianginal drugs	1110	0.23	0.52	0.14	-2.07
Nicorandil 10mg tablets : 139 Nicorandil 20mg tablets : 119