Static outliers for Darwen Healthlink

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 Darwen Healthlink is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Enzalutamide 4 Prostate cancer and gonadorelin analogues 161 0.02 0.00 0.00 26.60
Insulin glargine/lixisenatide 8 Intermediate and long-acting insulins 542 0.01 0.00 0.00 10.14
Methylprednisolone sodium succinate 1 Use of corticosteroids 1008 0.00 0.00 0.00 7.13
Tenoxicam 5 Non-steroidal anti-inflammatory drugs 2608 0.00 0.00 0.00 6.00
Diltiazem hydrochloride 1227 Calcium-channel blockers 6248 0.20 0.05 0.03 5.43
Diltiazem 120mg modified-release tablets : 113
Diltiazem 120mg modified-release capsules : 36
Diltiazem 180mg modified-release capsules : 106
Diltiazem 240mg modified-release capsules : 48
Tildiem Retard 120mg tablets : 95
Tildiem LA 300 capsules : 55
Tildiem LA 200 capsules : 50
Adizem-SR 120mg capsules : 36
Adizem-SR 180mg capsules : 45
Adizem-XL 300mg capsules : 33
Adizem-XL 180mg capsules : 37
Adizem-XL 240mg capsules : 36
Angitil SR 120 capsules : 62
Angitil SR 180 capsules : 37
Angitil XL 300 capsules : 40
Zemtard 120 XL capsules : 49
Zemtard 180 XL capsules : 40
Zemtard 240 XL capsules : 37
Viazem XL 180mg capsules : 1
Adizem-SR 90mg capsules : 14
Angitil SR 90 capsules : 14
Diltiazem 90mg modified-release tablets : 28
Diltiazem 200mg modified-release capsules : 23
Tildiem 60mg modified-release tablets : 18
Adizem-XL 120mg capsules : 27
Zemtard 300 XL capsules : 27
Tildiem Retard 90mg tablets : 22
Diltiazem 60mg modified-release tablets : 12
Viazem XL 120mg capsules : 7
Viazem XL 360mg capsules : 21
Diltiazem 300mg modified-release capsules : 6
Diltiazem 360mg modified-release capsules : 6
Viazem XL 240mg capsules : 6
Adizem-XL 200mg capsules : 20
Angitil XL 240 capsules : 15
Diltiazem 90mg modified-release capsules : 5

Prescribing where Darwen Healthlink is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Indapamide 268 Thiazides and related diuretics 2814 0.10 0.42 0.16 -2.06
Cetirizine hydrochloride 143 Antihistamines 1790 0.08 0.28 0.11 -1.89
Paracetamol 1092 Non-opioid analgesics and compound preparations 5569 0.20 0.48 0.16 -1.75
Salbutamol 3871 Selective beta(2)-agonists 4681 0.83 0.91 0.05 -1.73
Fluticasone furoate 9 Drugs used in nasal allergy 618 0.01 0.22 0.13 -1.65