Static outliers for Herefordshire And Worcestershire STP

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 Herefordshire And Worcestershire STP is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Cholesterol	24	Drugs used in metabolic disorders	30	0.80	0.02	0.12	6.23
Cholesterol 1g oral powder sachets : 24
Japanese encephalitis vaccine (Inactivated,adsorbed)	1	Vaccines and antisera	3742	0.00	0.00	0.00	6.22
Japanese encephalitis vacc (inact, adsorbed) inj 0.5ml pfs : 1
Magnesium sulfate	30	Magnesium	672	0.04	0.00	0.01	5.60
Magnesium sulfate 50% (magnesium 2mmol/ml) inj 2ml ampoules : 30
Alitretinoin	2	Preparations for eczema	6	0.33	0.02	0.06	4.90
Alitretinoin 30mg capsules : 2
Fenofibrate/simvastatin	3	Lipid-regulating drugs	412552	0.00	0.00	0.00	4.85
Fenofibrate 145mg / Simvastatin 40mg tablets : 3

Prescribing where Herefordshire And Worcestershire STP is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Gamolenic acid	3	Preparations for eczema	6	0.50	0.91	0.10	-4.07
Gamolenic acid 40mg capsules : 3
Amlodipine	154792	Calcium-channel blockers	254883	0.61	0.74	0.06	-2.40
Amlodipine 5mg tablets : 97889 Amlodipine 10mg tablets : 56387 Amlodipine 5mg/5ml oral solution sugar free : 64 Amlodipine 10mg/5ml oral solution sugar free : 19 Amlodipine 5mg/5ml oral suspension sugar free : 12 Amlodipine 2.5mg tablets : 328 Istin 5mg tablets : 39 Istin 10mg tablets : 54
Erythromycin	292	Topical preparations for acne	6592	0.04	0.12	0.03	-2.39
Erythromycin 40mg/ml / Zinc acetate 12mg/ml lotion : 135 Tretinoin 0.025% / Erythromycin 4% solution : 13 Zineryt lotion : 141 Aknemycin Plus solution : 3
Liquid paraffin	0	Faecal softeners	2	0.00	0.61	0.27	-2.23

Benzocaine	0	Lozenges and sprays	2	0.00	0.38	0.19	-1.98