Static outliers for Hastings & St Leonards 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 Hastings & St Leonards PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pristinamycin 5 Some other antibacterials 97 0.05 0.00 0.01 9.64
Timolol and brimonidine 310 Treatment of glaucoma 7617 0.04 0.01 0.01 6.13
Norethisterone enantate 1 Parenteral progestogen-only contraceptives 517 0.00 0.00 0.00 5.37
Dronedarone hydrochloride 214 Drugs for arrhythmias 1054 0.20 0.02 0.04 5.14
Olodaterol 35 Selective beta(2)-agonists 20747 0.00 0.00 0.00 4.82

Prescribing where Hastings & St Leonards PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tacrolimus 51 Drugs affecting the immune response 109 0.47 0.80 0.11 -2.97
Gliclazide 2909 Sulfonylureas 4756 0.61 0.93 0.11 -2.82
Permethrin 34 Parasiticidal preparations 60 0.57 0.85 0.12 -2.30
Beclometasone dipropionate 6411 Corticosteroids (respiratory) 18653 0.34 0.56 0.10 -2.29
Beclometasone 50micrograms/dose inhaler CFC free : 95
Beclometasone 100micrograms/dose inhaler CFC free : 202
Beclometasone 50micrograms/dose breath actuated inh CFC free : 1
Beclometasone 100mcg/dose breath actuated inhaler CFC free : 11
Beclometasone 200micrograms/dose inhaler CFC free : 12
Beclometasone 100microg/Formoterol 6microg/dose inh CFCfree : 73
Beclometasone 100microg/Formoterol 6microg/dose dry pdr inh : 39
Beclometasone 200microg/Formoterol 6microg/dose inh CFC free : 90
Beclometasone 200microg/Formoterol 6microg/dose dry pdr inh : 4
Qvar 50 inhaler : 230
Qvar 100 inhaler : 368
Qvar 50 Autohaler : 16
Qvar 100 Autohaler : 38
Qvar 50micrograms/dose Easi-Breathe inhaler : 6
Qvar 100micrograms/dose Easi-Breathe inhaler : 50
Easyhaler Beclometasone 200micrograms/dose dry pdr inhaler : 3
Clenil Modulite 50micrograms/dose inhaler : 577
Clenil Modulite 100micrograms/dose inhaler : 1960
Clenil Modulite 200micrograms/dose inhaler : 552
Clenil Modulite 250micrograms/dose inhaler : 21
Fostair 100micrograms/dose / 6micrograms/dose inhaler : 1251
Fostair 200micrograms/dose / 6micrograms/dose inhaler : 578
Fostair NEXThaler 100microg/dose / 6microg/dose dry pdr inh : 208
Fostair NEXThaler 200microg/dose / 6microg/dose dry pdr inh : 17
Soprobec 50micrograms/dose inhaler : 4
Soprobec 200micrograms/dose inhaler : 1
Soprobec 100micrograms/dose inhaler : 2
Soprobec 250micrograms/dose inhaler : 2
Atenolol 1849 Beta-adrenoceptor blocking drugs 33490 0.06 0.13 0.03 -2.24