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

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Zonisamide☰	382	Control of epilepsy	7999	0.05	0.01	0.00	9.67
Zonisamide 100mg capsules : 183 Zonisamide 25mg capsules : 152 Zonisamide 50mg capsules : 28 Zonisamide 100mg/5ml oral suspension : 1 Zonegran 25mg capsules : 1 Zonegran 50mg capsules : 9 Zonegran 100mg capsules : 8
Paracetamol and caffeine☰	4	Non-opioid analgesics and compound preparations	7995	0.00	0.00	0.00	8.25
Paracetamol 500mg / Caffeine 65mg efferv tab sugar free : 4
Glucose and ketone blood testing reagents☰	1	Diabetic diagnostic and monitoring agents	1442	0.00	0.00	0.00	8.04
KEYA Smart testing strips : 1
Ferrous gluconate☰	560	Oral iron	1983	0.28	0.04	0.03	7.07
Ferrous gluconate 300mg tablets : 560
Levofloxacin☰	60	Quinolones	134	0.45	0.05	0.06	7.03
Levofloxacin 500mg tablets : 48 Levofloxacin 250mg tablets : 12

Prescribing where Pathfields Medical Group PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	243	Skeletal muscle relaxants	724	0.34	0.81	0.12	-4.01
Baclofen 5mg/5ml oral solution sugar free : 11 Baclofen 10mg tablets : 232
Ciprofloxacin☰	72	Quinolones	134	0.54	0.85	0.08	-3.75
Ciprofloxacin 250mg tablets : 51 Ciprofloxacin 500mg tablets : 18 Ciprofloxacin 750mg tablets : 2 Ciprofloxacin 250mg/5ml oral suspension : 1
Azathioprine☰	70	Antiproliferative immunosuppressants	136	0.51	0.80	0.10	-2.80
Azathioprine 25mg tablets : 24 Azathioprine 50mg tablets : 46
Oral rehydration salts☰	13	Oral sodium and water	108	0.12	0.62	0.20	-2.48
Dioralyte oral powder sachets plain : 8 Dioralyte oral powder sachets blackcurrant : 5
Flecainide acetate☰	26	Drugs for arrhythmias	184	0.14	0.46	0.15	-2.10
Flecainide 100mg tablets : 10 Flecainide 50mg tablets : 15 Flecainide 25mg/5ml oral solution : 1