Static outliers for The Integrated Care Partnership

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 The Integrated Care Partnership is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Other topical corticosteroid preparations	4	Topical corticosteroids	1992	0.00	0.00	0.00	5.41
Propylene glycol 40% in Clobetasol 0.05% cream : 4
Ramipril with calcium channel blocker	21	Angiotensin-converting enzyme inhibitors	5701	0.00	0.00	0.00	5.33
Felodipine 5mg modified-release / Ramipril 5mg tablets : 21
Lacidipine	955	Calcium-channel blockers	6414	0.15	0.01	0.03	5.01
Lacidipine 2mg tablets : 446 Lacidipine 4mg tablets : 496 Motens 2mg tablets : 1 Motens 4mg tablets : 9 Lacidipine 6mg tablets : 3
Alogliptin/metformin	127	Other antidiabetic drugs	1412	0.09	0.00	0.02	4.66
Alogliptin 12.5mg / Metformin 1g tablets : 121 Vipdomet 12.5mg/1000mg tablets : 6
Mometasone/glycoyrronium/indacaterol	2	Corticosteroids (respiratory)	3302	0.00	0.00	0.00	4.23
Enerzair Breezhaler 114microg / 46microg / 136microg/dose : 2

Prescribing where The Integrated Care Partnership is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Ibuprofen	122	Rubefacients, topical NSAIDS, capsaicin and poultice	863	0.14	0.52	0.20	-1.85
Ibuprofen 5% gel : 69 Ibuprofen 10% gel : 49 Ibuleve Maximum Strength 10% gel : 2 Ibuprofen 5% spray : 1 Phorpain Maximum Strength 10% gel : 1
Hypromellose	88	Tear deficiency, eye lubricant/astringent	432	0.20	0.45	0.15	-1.64
Hypromellose 0.3% eye drops : 84 Hypromellose 0.5% eye drops : 1 Artelac Single Dose Unit 0.32% eye drops 0.5ml unit dose : 3
Ganciclovir	0	Antivirals	2	0.00	0.68	0.42	-1.60

Latanoprost	250	Treatment of glaucoma	1436	0.17	0.31	0.08	-1.59
Latanoprost 50micrograms/ml eye drops : 179 Latanoprost 50micrograms/ml eye dps 0.2ml ud preserv free : 36 Monopost 50micrograms/ml eye drops 0.2ml unit dose : 30 Xalatan 50micrograms/ml eye drops : 5
Rifampicin	1	Antituberculosis drugs	8	0.12	0.73	0.40	-1.50
Rifampicin 300mg capsules : 1