Static outliers for Avon Valley 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 Avon Valley PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Aminosalicylic acid☰	1	Antituberculosis drugs	1	1.00	0.00	0.04	22.45
Granupas gastro-resistant granules 4g sachets : 1
Dequalinium chloride☰	5	Vaginal and vulval infections	198	0.03	0.00	0.00	7.46
Dequalinium chloride 10mg vaginal tablets : 4 Fluomizin 10mg vaginal tablets : 1
Glycerol☰	1	Expectorant and demulcent cough preparations	4	0.25	0.01	0.05	4.52
Benylin Infant's Cough syrup : 1
Ciclesonide☰	128	Corticosteroids (respiratory)	7052	0.02	0.00	0.00	4.50
Ciclesonide 80micrograms/dose inhaler CFC free : 10 Ciclesonide 160micrograms/dose inhaler CFC free : 89 Alvesco 80 inhaler : 3 Alvesco 160 inhaler : 26
Olodaterol☰	10	Selective beta(2)-agonists	6404	0.00	0.00	0.00	4.44
Striverdi Respimat 2.5microg/dose inhalation soln : 10

Prescribing where Avon Valley PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Midazolam hydrochloride☰	9	Drugs used in status epilepticus	28	0.32	0.79	0.18	-2.53
Midazolam 5mg/1ml oromucosal soln pf oral syringes SF : 3 Midazolam 10mg/2ml oromucosal soln pf oral syringes SF : 3 Buccolam 10mg/2ml oromucosal soln pre-filled oral syringes : 3
Mercaptopurine☰	26	Antimetabolites	126	0.21	0.81	0.27	-2.21
Mercaptopurine 50mg tablets : 26
Rifampicin☰	0	Antituberculosis drugs	1	0.00	0.74	0.35	-2.12
Alendronic acid☰	2122	Bisphosphonates and other drugs	2971	0.71	0.87	0.07	-2.09
Alendronic acid 10mg tablets : 6 Alendronic acid 70mg tablets : 2102 Alendronic acid 70mg effervescent tablets sugar free : 14
Amiodarone hydrochloride☰	70	Drugs for arrhythmias	389	0.18	0.48	0.15	-1.98
Amiodarone 100mg tablets : 14 Amiodarone 200mg tablets : 56