Static outliers for Torentum 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 Torentum PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Olodaterol 22 Selective beta(2)-agonists 5221 0.00 0.0 0.0 12.58
Titanium dioxide 3 Sunscreening preparations 110 0.03 0.0 0.0 6.62
Fusidic acid 1 Some other antibacterials 44 0.02 0.0 0.0 6.35
Fosinopril sodium 24 Angiotensin-converting enzyme inhibitors 15797 0.00 0.0 0.0 5.87
Nadolol 48 Beta-adrenoceptor blocking drugs 16555 0.00 0.0 0.0 4.54

Prescribing where Torentum PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Salbutamol 4268 Selective beta(2)-agonists 5221 0.82 0.90 0.03 -2.69
Salbutamol 100micrograms/dose inhaler CFC free : 2952
Salbutamol 200micrograms/dose dry powder inhaler : 34
Salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials : 50
Salbutamol 5mg/2.5ml nebuliser liquid unit dose vials : 38
Salbutamol 2mg/5ml oral solution sugar free : 2
Salbutamol 100micrograms/dose breath actuated inh CFC free : 199
Salbutamol 100micrograms/dose dry powder inhaler : 7
Ventolin 200micrograms/dose Accuhaler : 103
Ventolin 100micrograms/dose Evohaler : 695
Ventolin 2.5mg Nebules : 8
Ventolin 5mg Nebules : 18
Salamol 100micrograms/dose inhaler CFC free (Teva) : 21
Salamol 100micrograms/dose Easi-Breathe inhaler : 72
Airomir 100micrograms/dose inhaler : 2
Airomir 100micrograms/dose Autohaler : 30
Easyhaler Salbutamol sulfate 100micrograms/dose dry pdr inh : 30
Easyhaler Salbutamol sulfate 200micrograms/dose dry pdr inh : 7
Estradiol 200 Oestrogens and Hormone Replacement Therapy 733 0.27 0.48 0.09 -2.30
Estradiol 2mg tablets : 21
Estradiol 0.06% gel (750microgram per actuation) : 18
Estradiol 25micrograms/24hours transdermal patches : 6
Estradiol 1mg tablets : 10
Estradiol 40micrograms/24hours transdermal patches : 10
Estradiol 500microgram gel sachets : 1
Estradiol 50micrograms/24hours transdermal patches : 10
Estradiol 100micrograms/24hours transdermal patches : 4
Estradiol 75micrograms/24hours transdermal patches : 2
Estraderm MX 25 patches : 1
Estraderm MX 50 patches : 7
Zumenon 2mg tablets : 3
Zumenon 1mg tablets : 4
Evorel 50 patches : 14
Evorel 25 patches : 6
Evorel 75 patches : 1
Evorel 100 patches : 6
Oestrogel Pump-Pack 0.06% gel : 25
Elleste Solo 1mg tablets : 11
Elleste Solo 2mg tablets : 5
Elleste Solo MX 40 transdermal patches : 9
Elleste Solo MX 80 transdermal patches : 1
Sandrena 500microgram gel sachets : 2
Sandrena 1mg gel sachets : 5
Estradot 75micrograms/24hours patches : 4
Estradot 100micrograms/24hours patches : 1
Estradot 25micrograms/24hours patches : 3
Estradot 50micrograms/24hours patches : 10
Fusidic acid 127 Antibacterial preparations also used systemically 248 0.51 0.73 0.09 -2.26
Famotidine 89 H2-Receptor antagonists 170 0.52 0.80 0.12 -2.23
Adapalene 7 Topical preparations for acne 295 0.02 0.12 0.04 -2.10