Static outliers for Ketts Oak 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 Ketts Oak PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Pericyazine☰	779	Antipsychotic drugs	4100	0.19	0.00	0.02	11.33
Pericyazine 10mg/5ml oral solution : 1 Pericyazine 2.5mg tablets : 748 Pericyazine 10mg tablets : 30
Neomycin sulfate☰	1	Antibacterial preparations only used topically	42	0.02	0.00	0.00	6.86
Neomycin 0.5% cream : 1
Meptazinol hydrochloride☰	493	Opioid analgesics	9759	0.05	0.00	0.01	4.67
Meptazinol 200mg tablets : 488 Meptid 200mg tablets : 5
Aclidinium bromide☰	488	Antimuscarinic bronchodilators	1840	0.27	0.05	0.05	4.60
Aclidinium bromide 375micrograms/dose dry powder inhaler : 33 Eklira 322micrograms/dose Genuair : 455
Methadone hydrochloride☰	128	Opioid analgesics	9759	0.01	0.00	0.00	4.28
Methadone 5mg tablets : 106 Methadone 10mg/1ml solution for injection ampoules : 22

Prescribing where Ketts Oak PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Somatropin☰	0	Hypothalamic & anterior pituitary hormone & antioestrogens	1	0.00	0.89	0.25	-3.49
Ramipril☰	7121	Angiotensin-converting enzyme inhibitors	22168	0.32	0.69	0.14	-2.72
Ramipril 1.25mg capsules : 856 Ramipril 2.5mg capsules : 2019 Ramipril 5mg capsules : 1966 Ramipril 10mg capsules : 2121 Ramipril 1.25mg tablets : 8 Ramipril 2.5mg tablets : 46 Ramipril 5mg tablets : 46 Ramipril 10mg tablets : 59
Amlodipine☰	12337	Calcium-channel blockers	22206	0.56	0.75	0.08	-2.33
Amlodipine 5mg tablets : 7685 Amlodipine 10mg tablets : 4630 Amlodipine 5mg/5ml oral solution sugar free : 4 Amlodipine 2.5mg tablets : 13 Istin 10mg tablets : 5
Losartan potassium☰	1579	Angiotensin-II receptor antagonists	11141	0.14	0.50	0.16	-2.29
Losartan 25mg tablets : 417 Losartan 50mg tablets : 566 Losartan 100mg tablets : 508 Losartan 12.5mg tablets : 88
Baclofen☰	537	Skeletal muscle relaxants	989	0.54	0.81	0.12	-2.26
Baclofen 5mg/5ml oral solution sugar free : 54 Baclofen 10mg tablets : 480 Lioresal 5mg/5ml liquid : 3