Static outliers for Fleetwood 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 Fleetwood PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gluten free/low protein drink 5 Foods for special diets 351 0.01 0.0 0.0 9.42
Avanafil 39 Drugs for erectile dysfunction 1047 0.04 0.0 0.0 9.36
Low protein grains/flours 11 Foods for special diets 351 0.03 0.0 0.0 8.47
Gluten free/low protein cereals 13 Foods for special diets 351 0.04 0.0 0.0 7.90
Ampicillin 5 Broad-spectrum penicillins 1340 0.00 0.0 0.0 7.50

Prescribing where Fleetwood PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Mesalazine (Systemic) 246 Aminosalicylates 722 0.34 0.64 0.10 -3.09
Mesalazine 400mg gastro-resistant tablets : 6
Mesalazine 500mg suppositories : 2
Mesalazine 250mg gastro-resistant tablets : 1
Mesalazine 500mg modified-release tablets : 18
Mesalazine 1g suppositories : 1
Mesalazine 1g/application foam enema : 2
Mesalazine 500mg gast res MR gran sachets sugar free : 8
Mesalazine 800mg gastro-resistant tablets : 12
Mesalazine 2g modified-release granules sachets sugar free : 8
Asacol 400mg MR gastro-resistant tablets : 18
Asacol 800mg MR gastro-resistant tablets : 102
Pentasa 500mg modified-release tablets : 3
Pentasa 1g modified-release granules sachets : 5
Pentasa 2g modified-release granules sachets : 9
Pentasa 1g modified-release tablets : 2
Salofalk 2g/59ml enema : 4
Salofalk 1g/application foam enema : 2
Salofalk 500mg gast res MR gran sachets : 1
Mezavant XL 1200mg tablets : 16
Octasa 800mg MR gastro-resistant tablets : 18
Octasa 400mg MR gastro-resistant tablets : 8
Estradiol 141 Oestrogens and Hormone Replacement Therapy 502 0.28 0.48 0.09 -2.21
Estradiol 2mg tablets : 17
Estradiol 0.06% gel (750microgram per actuation) : 14
Estradiol 25micrograms/24hours transdermal patches : 1
Estradiol 1mg tablets : 9
Estradiol 40micrograms/24hours transdermal patches : 2
Estradiol 80micrograms/24hours transdermal patches : 4
Estradiol 500microgram gel sachets : 5
Estradiol 50micrograms/24hours transdermal patches : 9
Estradiol 100micrograms/24hours transdermal patches : 2
Estradiol 75micrograms/24hours transdermal patches : 7
Estraderm MX 25 patches : 3
Estraderm MX 100 patches : 1
Zumenon 2mg tablets : 1
Zumenon 1mg tablets : 6
Evorel 50 patches : 13
Evorel 25 patches : 11
Evorel 100 patches : 2
Oestrogel Pump-Pack 0.06% gel : 14
Elleste Solo 1mg tablets : 8
Elleste Solo 2mg tablets : 3
Elleste Solo MX 40 transdermal patches : 2
Elleste Solo MX 80 transdermal patches : 1
Estradot 100micrograms/24hours patches : 2
Estradot 25micrograms/24hours patches : 2
Estradot 50micrograms/24hours patches : 2
Nicotine 3 Nicotine dependence 58 0.05 0.57 0.25 -2.08
Baclofen 285 Skeletal muscle relaxants 503 0.57 0.81 0.12 -2.06
Colchicine 52 Gout and cytotoxic induced hyperiuicaemia 1866 0.03 0.08 0.03 -2.03