Static outliers for Unity Medical Group 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 Unity Medical Group PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Benzocaine☰	1	Topical local anaesthetics and antipruritics	24	0.04	0.00	0.00	12.54
Benzocaine 3% cream : 1
Reboxetine☰	49	Other antidepressant drugs	2391	0.02	0.00	0.00	11.82
Reboxetine 4mg tablets : 49
Fluocortolone☰	5	Copound haemorrhoidal preparations with corticosteroid	139	0.04	0.00	0.00	11.58
Ultraproct ointment : 2 Ultraproct suppositories : 3
Sodium polystyrene sulfonate☰	3	Oral potassium	19	0.16	0.00	0.01	11.18
Sodium polystyrene sulfonate powder sugar free : 3
Hepatitis A/hepatitis B☰	11	Vaccines and antisera	43	0.26	0.01	0.02	10.75
Twinrix Adult vacc inj 1ml pre-filled syringes : 11

Prescribing where Unity Medical Group PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Prednisolone☰	476	Use of corticosteroids	626	0.76	0.88	0.03	-3.80
Prednisolone 1mg tablets : 99 Prednisolone 2.5mg tablets : 31 Prednisolone 5mg tablets : 214 Prednisolone 2.5mg gastro-resistant tablets : 16 Prednisolone 5mg gastro-resistant tablets : 78 Prednisolone 1mg gastro-resistant tablets : 35 Prednisolone 5mg soluble tablets : 3
Procyclidine hydrochloride☰	24	Antimuscarinic drugs used in parkinsonism	48	0.50	0.85	0.11	-3.28
Procyclidine 5mg tablets : 23 Kemadrin 5mg tablets : 1
Other multivitamin preparations☰	71	Multivitamin preparations	181	0.39	0.80	0.14	-2.91
Multivitamin tablets : 2 Forceval capsules : 53 Abidec Multivitamin drops : 4 Valupak Multivitamin One A Day tablets : 3 Forceval Soluble tablets : 4 Renavit tablets : 2 Paravit-cf capsules : 3
Medroxyprogesterone acetate☰	47	Parenteral progestogen-only contraceptives	83	0.57	0.86	0.11	-2.75
Medroxyprogesterone 150mg/1ml inj pre-filled syringes : 1 Depo-Provera 150mg/1ml inj pre-filled syringes : 46
Clonidine hydrochloride☰	0	Prophylaxis of migraine	16	0.00	0.35	0.13	-2.68