Static outliers for Bolton Central 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 Bolton Central PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Inosine pranobex☰	22	Herpes simplex and varicella-zoster	137	0.16	0.0	0.0	109.13
Inosine acedoben dimepranol 500mg tablets : 22
Alclometasone dipropionate☰	10	Topical corticosteroids	3888	0.00	0.0	0.0	24.64
Alclometasone 0.05% cream : 10
Tiopronin☰	2	Rheumatic disease suppressant drugs	609	0.00	0.0	0.0	17.58
Tiopronin 250mg tablets : 2
Tolnaftate☰	7	Antifungal preparations	606	0.01	0.0	0.0	15.50
Tolnaftate 1% liquid spray : 7
Trimetazidine hydrochloride☰	17	Calcium-channel blockers	12211	0.00	0.0	0.0	14.16
Trimetazidine 35mg modified-release tablets : 17

Prescribing where Bolton Central PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gliclazide☰	2944	Sulfonylureas	5032	0.59	0.93	0.11	-3.05
Gliclazide 80mg tablets : 2058 Gliclazide 30mg modified-release tablets : 79 Gliclazide 40mg tablets : 765 Gliclazide 60mg modified-release tablets : 27 Gliclazide 160mg tablets : 15
Aciclovir☰	115	Herpes simplex and varicella-zoster	137	0.84	0.95	0.04	-3.01
Aciclovir 200mg/5ml oral suspension sugar free : 9 Aciclovir 200mg tablets : 15 Aciclovir 400mg tablets : 50 Aciclovir 800mg tablets : 34 Aciclovir 800mg dispersible tablets : 5 Aciclovir 200mg dispersible tablets : 2
Progesterone☰	6	Progestogens and progesterone receptor modulators	159	0.04	0.54	0.20	-2.44
Progesterone 400mg pessaries : 1 Progesterone micronised 100mg capsules : 2 Cyclogest 200mg pessaries : 1 Utrogestan 100mg capsules : 2
Allopurinol☰	1085	Gout and cytotoxic induced hyperiuicaemia	1303	0.83	0.90	0.03	-2.32
Allopurinol 100mg tablets : 682 Allopurinol 300mg tablets : 403
Donepezil hydrochloride☰	201	Drugs for dementia	862	0.23	0.49	0.11	-2.25
Donepezil 5mg tablets : 37 Donepezil 10mg tablets : 155 Donepezil 10mg orodispersible tablets sugar free : 9