Static outliers for South Peterborough 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 South Peterborough PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Hydrocortisone butyrate☰	283	Topical corticosteroids	5923	0.05	0.0	0.0	12.15
Hydrocortisone butyrate 0.1% cream : 22 Hydrocortisone butyrate 0.1% ointment : 1 Hydrocortisone butyrate 0.1% scalp lotion : 5 Locoid 0.1% cream : 9 Locoid 0.1% Lipocream : 234 Locoid 0.1% ointment : 11 Locoid 0.1% scalp lotion : 1
Glycopyrronium/formoterol☰	26	Compound bronchodilator preparations	625	0.04	0.0	0.0	11.54
Glycopyrronium 7.2microg/Formoterol 5microg/dose inh CFCfree : 5 Bevespi Aerosphere 7.2microg / 5microg/dose pressurised inh : 21
Low protein desserts☰	23	Foods for special diets	746	0.03	0.0	0.0	6.15
Promin low protein dessert 36.5g sachets chocolate & banana : 6 Promin low protein dessert 36.5g sachets custard : 5 Promin low protein dessert 36.5g sachets caramel : 5 Taranis Pause low protein dessert strawberry : 2 Taranis Pause low protein dessert caramel : 5
Sodium oxybate☰	17	Hypnotics	4017	0.00	0.0	0.0	6.09
Sodium oxybate 500mg/ml oral solution sugar free : 17
Pyrimethamine☰	5	Antimalarials	1431	0.00	0.0	0.0	5.67
Pyrimethamine 25mg tablets : 5

Prescribing where South Peterborough PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	607	Skeletal muscle relaxants	1177	0.52	0.81	0.12	-2.49
Baclofen 5mg/5ml oral solution sugar free : 66 Baclofen 10mg tablets : 541
Diazepam☰	1793	Anxiolytics	2977	0.60	0.76	0.08	-2.03
Diazepam 5mg/2.5ml rectal solution tube : 6 Diazepam 10mg/2.5ml rectal solution tube : 3 Diazepam 2mg tablets : 1028 Diazepam 5mg tablets : 710 Diazepam 10mg tablets : 38 Diazepam 2mg/5ml oral solution sugar free : 8
Glucose blood testing reagents☰	3162	Diabetic diagnostic and monitoring agents	3514	0.90	0.94	0.02	-1.96
OneTouch Verio testing strips : 8 OneTouch Select Plus testing strips : 18 FreeStyle Optium testing strips : 63 GlucoMen LX Sensor testing strips : 5 GlucoMen areo Sensor testing strips : 705 Active testing strips : 3 FreeStyle testing strips : 3 FreeStyle Lite testing strips : 25 Aviva testing strips : 161 WaveSense JAZZ testing strips : 570 WaveSense JAZZ Duo testing strips : 40 Contour testing strips : 23 CareSens N testing strips : 4 Mobile cassette : 84 GlucoRx Q testing strips : 2 GlucoRx Nexus testing strips : 195 GlucoRx HCT Glucose testing strips : 35 GlucoLab testing strips : 7 Contour Next testing strips : 132 TRUEyou testing strips : 118 TEE2 testing strips : 1 Performa testing strips : 9 Finetest Lite testing strips : 19 CareSens PRO testing strips : 17 True Metrix testing strips : 2 4SURE testing strips : 208 Contour Plus testing strips : 692 Guide testing strips : 13
Neomycin sulfate☰	147	Nasal preparations for infection	207	0.71	0.84	0.07	-1.87
Neomycin 0.5% / Chlorhexidine hydrochloride 0.1% cream : 38 Naseptin nasal cream : 109
Benzoyl peroxide and clindamycin phosphate☰	170	Topical preparations for acne	696	0.24	0.37	0.08	-1.65
Benzoyl peroxide 5% / Clindamycin 1% gel : 24 Benzoyl peroxide 3% / Clindamycin 1% gel : 71 Duac Once Daily gel (5% and 1%) : 13 Duac Once Daily gel (3% and 1%) : 62