Static outliers for Fenland 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 Fenland PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Glycopyrronium bromide	1	Antiperspirants	1	1.00	0.01	0.04	22.67
Glycopyrronium bromide 0.5% in Aqueous cream : 1
Propamidine isetionate	3	Antibacterials	128	0.02	0.00	0.00	7.92
Brolene 0.1% eye drops : 3
Deferasirox	10	Hypoplastic/haemolytic and renal anaemias	10	1.00	0.02	0.14	7.01
Deferasirox 90mg tablets : 5 Deferasirox 360mg tablets : 5
Hydrocortisone butyrate	65	Topical corticosteroids	2333	0.03	0.00	0.00	6.79
Hydrocortisone butyrate 0.1% cream : 9 Hydrocortisone butyrate 0.1% ointment : 1 Hydrocortisone butyrate 0.1% scalp lotion : 2 Locoid 0.1% cream : 2 Locoid 0.1% Lipocream : 48 Locoid 0.1% ointment : 3
Ketoprofen	287	Rubefacients, topical NSAIDS, capsaicin and poultice	921	0.31	0.02	0.05	6.40
Ketoprofen 2.5% gel : 286 Powergel 2.5% gel : 1

Prescribing where Fenland PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Aluminium chloride	0	Antiperspirants	1	0.00	0.99	0.04	-22.22

Tacrolimus	11	Drugs affecting the immune response	29	0.38	0.80	0.11	-3.76
Tacrolimus 0.1% ointment : 3 Protopic 0.1% ointment : 6 Protopic 0.03% ointment : 2
Amoxicillin	950	Broad-spectrum penicillins	1506	0.63	0.80	0.07	-2.56
Amoxicillin 250mg capsules : 44 Amoxicillin 500mg capsules : 636 Amoxicillin 125mg/5ml oral suspension : 5 Amoxicillin 250mg/5ml oral suspension : 18 Amoxicillin 125mg/5ml oral suspension sugar free : 50 Amoxicillin 250mg/5ml oral suspension sugar free : 197
Gliclazide	1292	Sulfonylureas	2017	0.64	0.93	0.11	-2.56
Gliclazide 80mg tablets : 882 Gliclazide 30mg modified-release tablets : 10 Gliclazide 40mg tablets : 381 Gliclazide 60mg modified-release tablets : 14 Zicron 40mg tablets : 5
Atropine sulfate	7	Mydriatics and cycloplegics	30	0.23	0.75	0.22	-2.34
Atropine 1% eye drops : 1 Atropine 1% eye drops 0.5ml unit dose preservative free : 1 Minims atropine sulfate 1% eye drops 0.5ml unit dose : 5