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

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Clemastine fumarate☰	20	Antihistamines	9539	0.00	0.00	0.00	8.06
Clemastine 1mg tablets : 20
Chlorpromazine hydrochloride☰	1196	Antipsychotic drugs	9730	0.12	0.02	0.02	6.52
Chlorpromazine 25mg/5ml oral solution : 21 Chlorpromazine 100mg/5ml oral solution : 14 Chlorpromazine 25mg tablets : 535 Chlorpromazine 50mg tablets : 393 Chlorpromazine 100mg tablets : 211 Chlorpromazine 25mg/5ml oral solution sugar free : 22
Ciprofloxacin☰	78	Otitis externa	790	0.10	0.01	0.02	5.47
Ciprofloxacin 2mg/ml ear dps 0.25ml ud preservative free : 77 Cetraxal 2mg/ml ear drops 0.25ml unit dose : 1
Dithranol☰	27	Preparations for psoriasis	1027	0.03	0.00	0.00	5.09
Dithranol 0.25% cream : 1 Dithranol 0.1% cream : 4 Dithrocream 0.25% cream : 1 Dithrocream 1% cream : 6 Dithrocream 0.1% cream : 7 Dithrocream 0.5% cream : 8
Benzydamine hydrochloride☰	14	Rubefacients, topical NSAIDS, capsaicin and poultice	5653	0.00	0.00	0.00	4.52
Benzydamine 3% cream : 13 Difflam 3% cream : 1

Prescribing where North Liverpool PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Glucose blood testing reagents☰	3232	Diabetic diagnostic and monitoring agents	3637	0.89	0.94	0.02	-2.45
OneTouch Verio testing strips : 37 OneTouch Select Plus testing strips : 15 FreeStyle Optium testing strips : 210 GlucoMen LX Sensor testing strips : 7 GlucoMen areo Sensor testing strips : 214 Active testing strips : 5 Glucoflex-R testing strips : 1 FreeStyle testing strips : 8 FreeStyle Lite testing strips : 19 Aviva testing strips : 214 WaveSense JAZZ testing strips : 10 Contour testing strips : 346 CareSens N testing strips : 2 Mylife Pura testing strips : 5 Mobile cassette : 331 GlucoRx Nexus testing strips : 249 GlucoRx HCT Glucose testing strips : 53 Omnitest 5 testing strips : 1 palmdoc iCare Advanced testing strips : 5 BGStar testing strips : 10 Contour Next testing strips : 323 Mylife Unio testing strips : 1 TEE2 testing strips : 334 Contour TS testing strips : 86 GluNEO testing strips : 11 Performa testing strips : 315 Finetest Lite testing strips : 5 palmdoc testing strips : 1 True Metrix testing strips : 2 4SURE testing strips : 63 Contour Plus testing strips : 344 Kinetik Wellbeing testing strips : 4 Instant testing strips : 1
Potassium permanganate☰	1	Oxidisers and dyes	2	0.50	0.93	0.20	-2.19
Potassium permanganate 400mg tablets for cutaneous solution : 1
Water for injection☰	34	Electrolytes and water	74	0.46	0.81	0.17	-2.09
Water for injections 5ml ampoules : 5 Water for injections 10ml ampoules : 23 Water for injections 20ml ampoules : 1 Water for infusion 500ml polyethylene bottles : 1 Water for injections 500ml bottles : 2 Water for injections 5ml Mini-Plasco ampoules : 1 Polyfusor W water for infusion 500ml bottles : 1
Bisoprolol fumarate☰	14587	Beta-adrenoceptor blocking drugs	26393	0.55	0.65	0.06	-1.80
Bisoprolol 5mg tablets : 3222 Bisoprolol 10mg tablets : 1149 Bisoprolol 2.5mg tablets : 5354 Bisoprolol 3.75mg tablets : 829 Bisoprolol 7.5mg tablets : 496 Bisoprolol 1.25mg tablets : 3528 Cardicor 2.5mg tablets : 4 Cardicor 3.75mg tablets : 5
Rivaroxaban☰	674	Oral anticoagulants	11054	0.06	0.24	0.10	-1.75
Rivaroxaban 10mg tablets : 61 Rivaroxaban 15mg tablets : 219 Rivaroxaban 20mg tablets : 388 Rivaroxaban 2.5mg tablets : 6