Static outliers for Phoenix (Bnssg) 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 Phoenix (Bnssg) PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Bambuterol hydrochloride	23	Selective beta(2)-agonists	3649	0.01	0.00	0.00	11.03
Bambuterol 10mg tablets : 23
Rifabutin	1	Antituberculosis drugs	1	1.00	0.01	0.09	10.90
Rifabutin 150mg capsules : 1
Diclofenac sodium	5	Ocular diagnostic & peri-operative prepn & photodynamic tt	9	0.56	0.03	0.07	7.47
Voltarol Ophtha Multidose 0.1% eye drops : 5
Lacosamide	240	Control of epilepsy	5879	0.04	0.01	0.00	6.96
Lacosamide 50mg tablets : 105 Lacosamide 100mg tablets : 77 Lacosamide 150mg tablets : 21 Lacosamide 200mg tablets : 25 Lacosamide 10mg/ml oral solution sugar free : 9 Vimpat 100mg tablets : 3
Ibuprofen lysine	9	Non-steroidal anti-inflammatory drugs	2042	0.00	0.00	0.00	5.58
Ibuprofen lysine 200mg tablets : 9

Prescribing where Phoenix (Bnssg) PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Alfentanil hydrochloride	0	Opioid analgesics	2	0.00	0.85	0.34	-2.49

Co-amilofruse (Amiloride hydrochloride/frusemide)	10	Potassium sparing diuretics and compounds	40	0.25	0.70	0.19	-2.38
Co-amilofruse 5mg/40mg tablets : 6 Co-amilofruse 2.5mg/20mg tablets : 4
Neomycin sulfate	58	Nasal preparations for infection	84	0.69	0.84	0.07	-2.15
Neomycin 0.5% / Chlorhexidine hydrochloride 0.1% cream : 19 Naseptin nasal cream : 39
Rifampicin	0	Antituberculosis drugs	1	0.00	0.74	0.35	-2.12

Glycopyrronium bromide	0	Antimuscarinic drugs	1	0.00	0.78	0.37	-2.11