Static outliers for Beacon Medical Group 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 Beacon Medical Group PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Paracetamol and caffeine☰	6	Non-opioid analgesics and compound preparations	10822	0.00	0.00	0.00	9.15
Paracetamol 500mg / Caffeine 65mg efferv tab sugar free : 6
Levofloxacin☰	74	Quinolones	163	0.45	0.05	0.06	7.14
Levofloxacin 500mg tablets : 60 Levofloxacin 250mg tablets : 14
Dexamethasone phosphate☰	30	Use of corticosteroids	1823	0.02	0.00	0.00	6.42
Dexamethasone (base) 3.3mg/1ml inj ampoules : 30
Magnesium sulfate☰	3	Magnesium	30	0.10	0.00	0.02	4.80
Magnesium sulfate 50% (magnesium 2mmol/ml) inj 2ml ampoules : 3
Beclometasone dipropionate (Systemic)☰	14	Corticosteroids	38	0.37	0.03	0.08	4.25
Beclometasone 5mg gastro-resistant modified-release tablets : 3 Clipper 5mg gastro-resistant modified-release tablets : 11

Prescribing where Beacon Medical Group PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ciprofloxacin☰	57	Quinolones	163	0.35	0.85	0.08	-5.96
Ciprofloxacin 250mg tablets : 14 Ciprofloxacin 500mg tablets : 39 Ciprofloxacin 250mg/5ml oral suspension : 4
Budesonide☰	2	Corticosteroids	38	0.05	0.72	0.18	-3.62
Budesonide 2mg foam enema : 1 Budenofalk 3mg gastro-resistant capsules : 1
Urea hydrogen peroxide☰	1	Removal of ear wax and other substances	9	0.11	0.83	0.26	-2.79
Otex 5% ear drops : 1
Cefalexin☰	135	Cephalosporins	168	0.80	0.96	0.06	-2.74
Cefalexin 250mg capsules : 46 Cefalexin 500mg capsules : 71 Cefalexin 125mg/5ml oral suspension : 11 Cefalexin 250mg/5ml oral suspension : 3 Cefalexin 250mg tablets : 3 Cefalexin 500mg tablets : 1
Azathioprine☰	97	Antiproliferative immunosuppressants	174	0.56	0.80	0.10	-2.39
Azathioprine 25mg tablets : 20 Azathioprine 50mg tablets : 77