Static outliers for Preston North & East 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 Preston North & East PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Thioridazine 7 Antipsychotic drugs 7807 0.00 0.00 0.00 15.46
Levocetirizine 314 Antihistamines 8667 0.04 0.00 0.00 6.34
Dihydrocodeine tartrate 5193 Opioid analgesics 19383 0.27 0.06 0.04 5.42
Ertugliflozin 106 Other antidiabetic drugs 12283 0.01 0.00 0.00 4.25
Azelastine hydrochloride 119 Other anti-inflammatory preparations 604 0.20 0.06 0.04 3.55

Prescribing where Preston North & East PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Baclofen 911 Skeletal muscle relaxants 1777 0.51 0.81 0.12 -2.52
Codeine phosphate 34 Cough suppressants 94 0.36 0.78 0.21 -1.98
Macrogol 3350 4049 Osmotic laxatives 6995 0.58 0.72 0.07 -1.96
Macrogol compound oral powder sachets NPF sugar free : 874
Macrogol compound half-strength oral pdr sach NPF sugar free : 11
Macrogol compound oral liquid 25ml sachets NPF sugar free : 9
Macrogol 3350 oral powder 8.5g sachets sugar free : 16
Movicol oral powder 13.8g sachets lemon & lime : 221
Movicol-Half oral powder 6.9g sachets : 33
Movicol Plain oral powder 13.7g sachets : 32
Movicol Chocolate oral powder 13.9g sachets : 5
Movicol Liquid : 1
Movicol Paediatric Plain oral powder 6.9g sachets : 178
Movicol Paediatric Chocolate oral powder 6.9g sachets : 11
Laxido Orange oral powder sachets sugar free : 2292
Laxido Paediatric Plain oral powder 6.9g sachets : 334
CosmoCol Orange Lemon and Lime oral powder sachets : 9
CosmoCol Orange Flavour oral powder sachets : 6
CosmoCol Lemon and Lime Flavour oral powder sachets : 6
CosmoCol Paediatric oral powder 6.9g sachets : 7
CosmoCol Plain oral powder sachets : 4
Insulin aspart 881 Short-acting insulins 1403 0.63 0.79 0.09 -1.87
Calcium carbonate 117 Calcium supplements 134 0.87 0.96 0.05 -1.75