Static outliers for Waterside Health Network 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 Waterside Health Network PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Levofloxacin☰	82	Quinolones	178	0.46	0.05	0.06	7.26
Levofloxacin 500mg tablets : 76 Levofloxacin 250mg tablets : 6
Etodolac☰	572	Non-steroidal anti-inflammatory drugs	7497	0.08	0.01	0.01	5.97
Etodolac 600mg modified-release tablets : 568 Lodine SR 600mg tablets : 4
Triptorelin acetate☰	74	Prostate cancer and gonadorelin analogues	317	0.23	0.02	0.05	4.58
Triptorelin acetate 3mg inj vials : 6 Decapeptyl SR 3mg inj vials : 68
Beclometasone dipropionate (Systemic)☰	32	Corticosteroids	86	0.37	0.03	0.08	4.30
Clipper 5mg gastro-resistant modified-release tablets : 32
Olsalazine sodium☰	28	Aminosalicylates	867	0.03	0.00	0.01	3.70
Olsalazine 250mg capsules : 5 Olsalazine 500mg tablets : 23

Prescribing where Waterside Health Network PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ciprofloxacin☰	93	Quinolones	178	0.52	0.85	0.08	-3.92
Ciprofloxacin 250mg tablets : 40 Ciprofloxacin 500mg tablets : 47 Ciprofloxacin 750mg tablets : 1 Ciprofloxacin 250mg/5ml oral suspension : 5
Baclofen☰	364	Skeletal muscle relaxants	942	0.39	0.81	0.12	-3.58
Baclofen 5mg/5ml oral solution sugar free : 23 Baclofen 10mg tablets : 341
Flecainide acetate☰	38	Drugs for arrhythmias	350	0.11	0.46	0.15	-2.32
Flecainide 100mg tablets : 5 Flecainide 50mg tablets : 33
Pravastatin sodium☰	183	Lipid-regulating drugs	29614	0.01	0.03	0.01	-2.11
Pravastatin 10mg tablets : 48 Pravastatin 20mg tablets : 76 Pravastatin 40mg tablets : 59
Fexofenadine hydrochloride☰	1121	Antihistamines	6537	0.17	0.36	0.09	-2.08
Fexofenadine 120mg tablets : 459 Fexofenadine 180mg tablets : 639 Fexofenadine 30mg tablets : 13 Telfast 120mg tablets : 5 Telfast 180mg tablets : 5