Static outliers for South Coastal 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 South Coastal Medical Group PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Chlordiazepoxide hydrochloride☰	84	Anxiolytics	646	0.13	0.01	0.01	18.49
Chlordiazepoxide 5mg capsules : 1 Chlordiazepoxide 10mg capsules : 83
Undecenoates☰	12	Antifungal preparations	384	0.03	0.00	0.00	8.12
Zinc undecenoate 20% / Undecenoic acid 5% cream : 1 Mycota cream : 4 Mycota powder : 7
Triptorelin embonate☰	42	Prostate cancer and gonadorelin analogues	141	0.30	0.02	0.04	6.51
Decapeptyl SR 22.5mg inj vials : 42
Magnesium hydroxide☰	6	Osmotic laxatives	2350	0.00	0.00	0.00	6.04
Magnesium hydroxide 8% oral suspension : 6
Chlorhex hydrochloride☰	1	Preparations for minor cuts and abrasions	3	0.33	0.01	0.06	5.30
Chlorhexidine hydrochloride 0.5% cream : 1

Prescribing where South Coastal Medical Group PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Diazepam☰	348	Anxiolytics	646	0.54	0.76	0.08	-2.84
Diazepam 2mg/5ml oral solution : 1 Diazepam 5mg/2.5ml rectal solution tube : 3 Diazepam 10mg/2.5ml rectal solution tube : 2 Diazepam 2mg tablets : 204 Diazepam 5mg tablets : 94 Diazepam 10mg tablets : 43 Diazepam 2mg/5ml oral solution sugar free : 1
Gliclazide☰	606	Sulfonylureas	978	0.62	0.93	0.11	-2.75
Gliclazide 80mg tablets : 357 Gliclazide 30mg modified-release tablets : 27 Gliclazide 40mg tablets : 204 Gliclazide 60mg modified-release tablets : 12 Diamicron 80mg tablets : 6
Mercaptopurine☰	10	Antimetabolites	131	0.08	0.81	0.27	-2.68
Mercaptopurine 50mg tablets : 10
Methylprednisolone acetate☰	1	Local corticosteroid injections	545	0.00	0.73	0.29	-2.50
Depo-Medrone with Lidocaine inj 2ml vials : 1
Amiodarone hydrochloride☰	26	Drugs for arrhythmias	190	0.14	0.48	0.15	-2.26
Amiodarone 100mg tablets : 10 Amiodarone 200mg tablets : 16