Static outliers for Robert Darbishire Practice 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 Robert Darbishire Practice PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Sodium zirconium cyclosilicate	15	Oral potassium	31	0.48	0.01	0.03	17.33
Lokelma 5g oral powder sachets : 15
Fondaparinux sodium	4	Parenteral anticoagulants	18	0.22	0.01	0.02	10.65
Fondaparinux sodium 10mg/0.8ml inj pre-filled syringes : 4
Squill	1	Expectorant and demulcent cough preparations	9	0.11	0.00	0.01	10.46
Covonia mentholated cough mixture : 1
Tetracaine	66	Local anaesthetics	200	0.33	0.02	0.03	9.40
Tetracaine 4% gel : 19 Ametop 4% gel : 19 Ametop 4% gel dispensing pack : 28
Acetic acid	46	Otitis externa	191	0.24	0.04	0.03	6.16
Acetic acid 2% ear spray : 34 EarCalm 2% spray : 12

Prescribing where Robert Darbishire Practice PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Potassium chloride	15	Oral potassium	31	0.48	0.98	0.06	-7.94
Sando-K effervescent tablets : 15
Lidocaine hydrochloride	129	Local anaesthetics	200	0.64	0.91	0.07	-3.72
Lidocaine 2% and Chlorhexidine gel : 2 Lidocaine 5% medicated plasters : 18 Instillagel gel : 6 Emla 5% cream : 102 Bonjela Junior gel : 1
Nicorandil	46	Other antianginal drugs	337	0.14	0.52	0.14	-2.75
Nicorandil 10mg tablets : 27 Nicorandil 20mg tablets : 19
Aciclovir	69	Herpes simplex and varicella-zoster	81	0.85	0.95	0.04	-2.67
Aciclovir 200mg/5ml oral suspension sugar free : 2 Aciclovir 200mg tablets : 17 Aciclovir 400mg tablets : 35 Aciclovir 800mg tablets : 13 Aciclovir 200mg dispersible tablets : 1 Aciclovir 400mg dispersible tablets : 1
Desogestrel	187	Oral progestogen-only contraceptives	214	0.87	0.94	0.03	-2.51
Desogestrel 75microgram tablets : 35 Cerazette 75microgram tablets : 70 Cerelle 75microgram tablets : 32 Zelleta 75microgram tablets : 50