Static outliers for Nuneaton North 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 Nuneaton North PCN is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Fluocinonide☰	31	Topical corticosteroids	2541	0.01	0.00	0.00	7.83
Fluocinonide 0.05% cream : 3 Fluocinonide 0.05% ointment : 4 Metosyn FAPG 0.05% cream : 7 Metosyn 0.05% ointment : 17
Benperidol☰	24	Antipsychotic drugs	3684	0.01	0.00	0.00	5.61
Benperidol 250microgram tablets : 24
Lofepramine hydrochloride☰	194	Tricyclic and related antidepressant drugs	5795	0.03	0.01	0.01	4.11
Lofepramine 70mg tablets : 194
Vortioxetine☰	344	Other antidepressant drugs	5887	0.06	0.01	0.01	3.67
Vortioxetine 5mg tablets : 56 Vortioxetine 10mg tablets : 150 Vortioxetine 20mg tablets : 138
Heparinoid☰	224	Rubefacients, topical NSAIDS, capsaicin and poultice	1920	0.12	0.03	0.03	3.52
Salicylic acid 2% / Mucopolysaccharide polysulfate 0.2% gel : 152 Salicylic acid 2% / Mucopolysaccharide polysulfate 0.2% crm : 2 Movelat cream : 23 Movelat gel : 47

Prescribing where Nuneaton North PCN is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sulfasalazine☰	117	Aminosalicylates	834	0.14	0.34	0.09	-2.13
Sulfasalazine 500mg tablets : 21 Sulfasalazine 500mg gastro-resistant tablets : 61 Salazopyrin 500mg tablets : 3 Salazopyrin EN-Tabs 500mg : 32
Olanzapine☰	412	Antipsychotic drugs	3684	0.11	0.23	0.05	-2.09
Olanzapine 5mg tablets : 70 Olanzapine 7.5mg tablets : 27 Olanzapine 10mg tablets : 164 Olanzapine 2.5mg tablets : 93 Olanzapine 15mg tablets : 17 Olanzapine 20mg tablets : 39 Olanzapine 10mg orodispersible tablets : 1 Olanzapine 20mg orodispersible tablets : 1
Mercaptopurine☰	4	Antimetabolites	16	0.25	0.81	0.27	-2.05
Mercaptopurine 50mg tablets : 4
Mupirocin☰	2	Nasal preparations for infection	74	0.03	0.16	0.07	-1.89
Mupirocin 2% nasal ointment : 2
Mometasone furoate☰	352	Drugs used in nasal allergy	2673	0.13	0.31	0.10	-1.88
Mometasone 50micrograms/dose nasal spray : 324 Nasonex 50micrograms/dose nasal spray : 28