Static outliers for Clacton Community Practices

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 Clacton Community Practices is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Hydrocortisone acetate☰	2	Corticosteroids	25	0.08	0.00	0.01	9.98
Hydrocortisone 10% foam aerosol enema : 2
Galantamine☰	119	Drugs for dementia	463	0.26	0.03	0.06	3.74
Luventa XL 16mg capsules : 71 Galzemic XL 16mg capsules : 18 Gazylan XL 16mg capsules : 22 Galantamine 16mg modified-release capsules : 3 Luventa XL 8mg capsules : 5
Beclometdiprop/formoterol/glycopyrronium☰	1064	Selective beta(2)-agonists	5828	0.18	0.06	0.04	2.93
Trimbow 87microg/dose / 5microg/dose / 9microg/dose inh : 1064
Clonazepam☰	684	Control of epilepsy	7193	0.10	0.03	0.02	2.73
Clonazepam 500microgram tablets : 663 Clonazepam 2mg tablets : 21
Brinzolamide and timolol☰	160	Treatment of glaucoma	2174	0.07	0.02	0.02	2.67
Brinzolamide 10mg/ml / Timolol 5mg/ml eye drops : 136 Azarga 10mg/ml / 5mg/ml eye drops : 24

Prescribing where Clacton Community Practices is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Salbutamol☰	4538	Selective beta(2)-agonists	5828	0.78	0.91	0.05	-2.79
Salbutamol 100micrograms/dose inhaler CFC free : 931 Salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials : 144 Salbutamol 5mg/2.5ml nebuliser liquid unit dose vials : 52 Salbutamol 100micrograms/dose breath actuated inh CFC free : 139 Ventolin 200micrograms/dose Accuhaler : 111 Ventolin 100micrograms/dose Evohaler : 3032 Salamol 100micrograms/dose Easi-Breathe inhaler : 91 Ventolin 2.5mg Nebules : 1 Airomir 100micrograms/dose inhaler : 1 Salamol 100micrograms/dose inhaler CFC free (Teva) : 14 Easyhaler Salbutamol sulfate 200micrograms/dose dry pdr inh : 7 Salbutamol 200micrograms/dose dry powder inhaler : 5 Airomir 100micrograms/dose Autohaler : 5 Easyhaler Salbutamol sulfate 100micrograms/dose dry pdr inh : 5
Methylprednisolone acetate☰	0	Local corticosteroid injections	1	0.00	0.73	0.39	-1.87
Prednisolone☰	2	Copound haemorrhoidal preparations with corticosteroid	142	0.01	0.41	0.24	-1.65
Cinchocaine 0.5% / Prednisolone 0.19% ointment : 1 Cinchocaine 1mg / Prednisolone hexanoate 1.3mg suppositories : 1
Hydrocortisone☰	300	Topical corticosteroids	1181	0.25	0.34	0.06	-1.35
Hydrocortisone 1% cream : 76 Hydrocortisone 1% / Miconazole 2% cream : 129 Hydrocortisone 0.25% / Crotamiton 10% cream : 2 Hydrocortisone 0.5% ointment : 2 Oxytetracycline 3% / Hydrocortisone 1% ointment : 2 Nystatin 100,000u/g / Chlorhex acetate 1%/ Hydrocort 1% oint : 2 Eurax Hc cream : 1 Daktacort ointment : 1 Canesten HC cream : 1 Daktacort 2%/1% cream : 14 Hydrocortisone 0.5% cream : 9 Hydrocortisone 2.5% ointment : 3 Mildison Lipocream 1% cream : 3 Timodine cream : 7 Hydrocortisone 1% ointment : 16 Hydrocortisone 1% / Clotrimazole 1% cream : 16 Hydrocortisone 1% / Miconazole 2% ointment : 11 Hydrocortisone 0.1% cream : 5
Magnesium aspartate☰	0	Magnesium	17	0.00	0.54	0.40	-1.35