Static outliers for Orpington 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 Orpington PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Norethisterone enantate	1	Parenteral progestogen-only contraceptives	206	0.00	0.00	0.00	13.57
Noristerat 200mg/1ml solution for injection ampoules : 1
Buprenorphine	2475	Opioid analgesics	6125	0.40	0.12	0.06	4.44
Buprenorphine 200microgram sublingual tablets sugar free : 4 Buprenorphine 35micrograms/hour transdermal patches : 7 Buprenorphine 52.5micrograms/hour transdermal patches : 3 Buprenorphine 70micrograms/hour transdermal patches : 3 Buprenorphine 5micrograms/hour transdermal patches : 162 Buprenorphine 10micrograms/hour transdermal patches : 105 Buprenorphine 20micrograms/hour transdermal patches : 36 Buprenorphine 15micrograms/hour transdermal patches : 55 Transtec 35micrograms/hour transdermal patches : 9 BuTrans 5micrograms/hour transdermal patches : 18 BuTrans 10micrograms/hour transdermal patches : 8 BuTrans 20micrograms/hour transdermal patches : 5 BuTrans 15micrograms/hour transdermal patches : 4 Butec 5micrograms/hour transdermal patches : 753 Butec 10micrograms/hour transdermal patches : 594 Butec 20micrograms/hour transdermal patches : 239 Butec 15micrograms/hour transdermal patches : 167 Sevodyne 5micrograms/hour transdermal patches : 142 Sevodyne 10micrograms/hour transdermal patches : 86 Sevodyne 20micrograms/hour transdermal patches : 41 Sevodyne 15micrograms/hour transdermal patches : 27 Bunov 10micrograms/hour transdermal patches : 7
Neomycin sulfate	1	Aminoglycosides	1	1.00	0.06	0.22	4.34
Neomycin 500mg tablets : 1
Low protein miscellaneous	4	Foods for special diets	559	0.01	0.00	0.00	3.95
Taranis low protein hazelnut spread : 4
Sulfur	1	Topical preparations for acne	638	0.00	0.00	0.00	3.89
Salicylic acid 2% / Sulfur 2% in Aqueous cream : 1

Prescribing where Orpington PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Pizotifen malate	31	Prophylaxis of migraine	121	0.26	0.65	0.13	-3.03
Pizotifen 500microgram tablets : 26 Pizotifen 1.5mg tablets : 5
Potassium permanganate	2	Oxidisers and dyes	5	0.40	0.93	0.20	-2.69
Potassium permanganate 400mg tablets for cutaneous solution : 2
Sildenafil (Erectile Dysfunction)	693	Drugs for erectile dysfunction	1080	0.64	0.77	0.05	-2.30
Sildenafil 50mg tablets : 276 Sildenafil 25mg tablets : 16 Sildenafil 100mg tablets : 396 Viagra 100mg tablets : 5
Diazepam	773	Anxiolytics	1260	0.61	0.76	0.08	-1.88
Diazepam 10mg/2.5ml rectal solution tube : 6 Diazepam 2mg tablets : 467 Diazepam 5mg tablets : 266 Diazepam 10mg tablets : 33 Diazepam 2mg/5ml oral suspension : 1
Spironolactone	742	Potassium-sparing diuretics and aldosterone antagonists	1367	0.54	0.72	0.10	-1.87
Spironolactone 25mg tablets : 584 Spironolactone 50mg tablets : 94 Spironolactone 100mg tablets : 57 Spironolactone 50mg/5ml oral solution : 4 Spironolactone 12.5mg tablets : 3