Static outliers for Ashford Stour 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 Ashford Stour PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Zuclopenthixol acetate☰	3	Antipsychotic drugs	3295	0.00	0.00	0.00	19.49
Zuclopenthixol acetate 50mg/1ml inj ampoules : 3
Atenolol with calcium channel blocker☰	43	Beta-adrenoceptor blocking drugs	17205	0.00	0.00	0.00	5.33
Atenolol 50mg / Nifedipine 20mg modified-release capsules : 14 Tenif 50mg/20mg modified-release capsules : 29
Tafluprost and timolol☰	115	Treatment of glaucoma	4316	0.03	0.00	0.01	4.51
Tafluprost 15microg/Timolol 5mg/ml eye dps 0.3ml : 12 Taptiqom 15micrograms/ml / 5mg/ml eye drops 0.3ml unit dose : 103
Methoxy polyethylene glycol-epoetin beta☰	3	Hypoplastic/haemolytic and renal anaemias	4	0.75	0.04	0.18	4.04
Mircera 50micrograms/0.3ml inj pre-filled syringes : 3
Enalapril maleate with diuretic☰	34	Angiotensin-converting enzyme inhibitors	19547	0.00	0.00	0.00	3.44
Enalapril 20mg / Hydrochlorothiazide 12.5mg tablets : 19 Innozide 20mg/12.5mg tablets : 15

Prescribing where Ashford Stour PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Furosemide☰	3118	Loop diuretics	4517	0.69	0.85	0.07	-2.31
Furosemide 20mg tablets : 1383 Furosemide 40mg tablets : 1721 Furosemide 500mg tablets : 2 Furosemide 40mg/5ml oral solution sugar free : 6 Furosemide 50mg/5ml oral solution sugar free : 1 Furosemide 20mg/5ml oral solution sugar free : 5
Other emollient preparations☰	1576	Emollients	1939	0.81	0.89	0.04	-1.79
White soft paraffin 50% / Liquid paraffin 50% ointment : 67 Isopropyl myristate 15% / Liquid paraffin 15% gel : 10 Diprobase ointment : 44 Ultrabase cream : 3 E45 lotion : 23 E45 cream : 65 Lotil cream : 1 Aveeno cream : 193 CCS Foot Care cream : 3 Dermol 500 lotion : 614 Unguentum M cream : 2 Doublebase gel : 175 Aveeno lotion : 65 Oilatum cream : 44 Aveeno Skin Relief moisturising lotion with shea butter : 5 Dermol cream : 100 Oilatum Junior cream : 7 Doublebase Dayleve gel : 50 Aveeno moisturising creamy oil : 1 Doublebase emollient shower gel : 59 Doublebase emollient wash gel : 45
Isosorbide mononitrate☰	934	Nitrates	1521	0.61	0.73	0.07	-1.75
Isosorbide mononitrate 10mg tablets : 92 Isosorbide mononitrate 20mg tablets : 55 Isosorbide mononitrate 40mg tablets : 11 Isosorbide mononitrate 60mg modified-release tablets : 51 Isosorbide mononitrate 40mg modified-release tablets : 20 Isosorbide mononitrate 25mg modified-release capsules : 29 Isosorbide mononitrate 40mg modified-release capsules : 18 Isosorbide mononitrate 25mg modified-release tablets : 5 Elantan LA50 capsules : 6 Isotard 40XL tablets : 11 Monomax XL 60mg tablets : 45 Monomil XL 60mg tablets : 591
Ramipril☰	9156	Angiotensin-converting enzyme inhibitors	19547	0.47	0.69	0.14	-1.65
Ramipril 1.25mg capsules : 936 Ramipril 2.5mg capsules : 2468 Ramipril 5mg capsules : 2569 Ramipril 10mg capsules : 3060 Ramipril 1.25mg tablets : 13 Ramipril 2.5mg tablets : 60 Ramipril 5mg tablets : 25 Ramipril 10mg tablets : 20 Ramipril 2.5mg/5ml oral solution sugar free : 5
Timolol☰	100	Treatment of glaucoma	4316	0.02	0.06	0.02	-1.58
Timolol 0.25% eye drops : 21 Timolol 0.5% eye drops : 23 Timolol 0.25% eye gel : 2 Timolol 0.5% eye gel : 3 Timolol 1mg/g gel eye drops 0.4g unit dose preservative free : 35 Timoptol-LA 0.25% ophthalmic gel-forming solution : 1 Tiopex 1mg/g eye gel 0.4g unit dose : 15