Static outliers for Hambleton North 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 Hambleton North PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Clomethiazole 155 Hypnotics 2032 0.08 0.00 0.00 22.32
Taurine 4 Amino acids and nutritional agents 4 1.00 0.04 0.17 5.60
Degarelix 145 Prostate cancer and gonadorelin analogues 623 0.23 0.03 0.05 4.15
Ciprofloxacin 63 Antibacterials 258 0.24 0.06 0.05 3.95
Other calcium supplement preparations 27 Calcium supplements 129 0.21 0.04 0.05 3.69

Prescribing where Hambleton North PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other amino acidandnutritional agent preparations 0 Amino acids and nutritional agents 4 0.00 0.96 0.17 -5.60
Calcium carbonate 102 Calcium supplements 129 0.79 0.96 0.05 -3.42
Potassium citrate 1 Drugs used in urological pain 3 0.33 0.93 0.18 -3.29
Salbutamol 6338 Selective beta(2)-agonists 7669 0.83 0.90 0.03 -2.41
Salbutamol 100micrograms/dose inhaler CFC free : 4853
Salbutamol 200micrograms/dose dry powder inhaler : 10
Salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials : 104
Salbutamol 5mg/ml nebuliser liquid : 1
Salbutamol 5mg/2.5ml nebuliser liquid unit dose vials : 20
Salbutamol 2mg/5ml oral solution sugar free : 7
Salbutamol 100micrograms/dose breath actuated inh CFC free : 206
Salbutamol 100micrograms/dose dry powder inhaler : 3
Ventolin 200micrograms/dose Accuhaler : 43
Ventolin 100micrograms/dose Evohaler : 322
Ventolin 2.5mg Nebules : 14
Salamol 100micrograms/dose inhaler CFC free (Teva) : 481
Salamol 100micrograms/dose Easi-Breathe inhaler : 170
Airomir 100micrograms/dose Autohaler : 15
Easyhaler Salbutamol sulfate 100micrograms/dose dry pdr inh : 76
Easyhaler Salbutamol sulfate 200micrograms/dose dry pdr inh : 13
Ramipril 7253 Angiotensin-converting enzyme inhibitors 19306 0.38 0.69 0.14 -2.33