Static outliers for Cumbria And North East 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 Cumbria And North East STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cholesterol/simvastatin 1 Preparations for psoriasis 34553 0.00 0.0 0.0 6.33
Procarbazine hydrochloride 1 Other antineoplastic drugs 1374 0.00 0.0 0.0 6.33
Ephedrine hydrochloride 1 Vasoconstrictor sympathomimetics 3356 0.00 0.0 0.0 6.33
Zidovudine 1 HIV infection 37 0.03 0.0 0.0 6.25
Other topical circulatory preparations 3 Topical circulatory preparations 1470 0.00 0.0 0.0 6.08

Prescribing where Cumbria And North East STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Midodrine hydrochloride 3355 Vasoconstrictor sympathomimetics 3356 1.00 1.00 0.00 -6.33
Heparinoid 1467 Topical circulatory preparations 1470 1.00 1.00 0.00 -6.08
Co-codamol (Codeine phosphate/paracetamol) 193620 Non-opioid analgesics and compound preparations 963640 0.20 0.45 0.08 -3.01
Co-codamol 8mg/500mg tablets : 46231
Co-codamol 8mg/500mg capsules : 2696
Co-codamol 8mg/500mg effervescent tablets : 5320
Co-codamol 30mg/500mg capsules : 19476
Co-codamol 30mg/500mg effervescent tablets : 6866
Co-codamol 30mg/500mg tablets : 84006
Co-codamol 15mg/500mg tablets : 21919
Co-codamol 12.8mg/500mg tablets : 31
Co-codamol 15mg/500mg capsules : 3507
Co-codamol 15mg/500mg effervescent tablets sugar free : 40
Co-codamol 30mg/500mg/5ml oral solution sugar free : 2
Co-codamol 8mg/500mg effervescent tablets sugar free : 85
Tylex 30mg/500mg capsules : 382
Solpadol 30mg/500mg effervescent tablets : 641
Solpadol 30mg/500mg caplets : 888
Solpadol 30mg/500mg capsules : 128
Kapake 30mg/500mg tablets : 390
Kapake 30mg/500mg capsules : 71
Solpadeine Max 12.8mg/500mg tablets : 2
Zapain 30mg/500mg tablets : 758
Zapain 30mg/500mg capsules : 19
Codipar 15mg/500mg tablets : 10
Codipar 15mg/500mg capsules : 7
Migraleve Yellow tablets : 145
Prochlorperazine maleate 34255 Drugs used in nausea and vertigo 188214 0.18 0.25 0.02 -2.84
Amitriptyline hydrochloride 483140 Tricyclic and related antidepressant drugs 637512 0.76 0.85 0.03 -2.83