Static outliers for Pennine Medical Centre

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 Pennine Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sodium fusidate☰	3	Some other antibacterials	6	0.50	0.01	0.07	6.85
Sodium fusidate 250mg tablets : 3
Magnesium citrate☰	1	Bowel cleansing preparations	1	1.00	0.03	0.17	5.84
Citramag effervescent powder sachets : 1
Promazine hydrochloride☰	147	Antipsychotic drugs	648	0.23	0.01	0.04	5.75
Promazine 25mg/5ml oral solution : 125 Promazine 50mg tablets : 1 Promazine 50mg/5ml oral solution : 11 Promazine 25mg tablets : 10
Dabigatran etexilate☰	166	Oral anticoagulants	1272	0.13	0.02	0.02	5.55
Dabigatran etexilate 110mg capsules : 72 Dabigatran etexilate 150mg capsules : 89 Dabigatran etexilate 75mg capsules : 5
Methocarbamol☰	55	Skeletal muscle relaxants	76	0.72	0.08	0.15	4.20
Methocarbamol 750mg tablets : 55

Prescribing where Pennine Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	18	Skeletal muscle relaxants	76	0.24	0.83	0.18	-3.20
Baclofen 10mg tablets : 13 Baclofen 5mg/5ml oral solution sugar free : 5
Quinine sulfate☰	156	Antimalarials	257	0.61	0.89	0.14	-2.02
Quinine sulfate 200mg tablets : 105 Quinine sulfate 300mg tablets : 51
Folic acid☰	307	Drugs used in megaloblastic anaemias	789	0.39	0.70	0.16	-1.95
Folic acid 5mg tablets : 302 Folic acid 400microgram tablets : 1 Folic acid 2.5mg/5ml oral solution sugar free : 4
Ivermectin☰	3	Topical preparation for rosacea	7	0.43	0.88	0.24	-1.90
Soolantra 10mg/g cream : 2 Ivermectin 10mg/g cream : 1
Amlodipine☰	1995	Calcium-channel blockers	3668	0.54	0.75	0.11	-1.86
Amlodipine 5mg tablets : 1098 Amlodipine 10mg tablets : 897