Static outliers for Humber, Coast And Vale 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 Humber, Coast And Vale STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Tezacaftor/ivacaftor 1 Mucolytics 39851 0.0 0.0 0.0 6.33
Triamterene 1 Potassium-sparing diuretics and aldosterone antagonists 61857 0.0 0.0 0.0 6.33
Flunisolide 3 Drugs used in nasal allergy 112547 0.0 0.0 0.0 6.33
Alprazolam 1 Anxiolytics 59729 0.0 0.0 0.0 6.33
Phenprocoumon 1 Oral anticoagulants 305741 0.0 0.0 0.0 6.33

Prescribing where Humber, Coast And Vale STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Aciclovir 1432 Antiviral preparations 1439 1.00 1.00 0.00 -3.02
Other amino acidandnutritional agent preparations 555 Amino acids and nutritional agents 723 0.77 0.97 0.08 -2.40
Menadiol sodium phosphate 19 Vitamin K 192 0.10 0.46 0.15 -2.39
Dexamethasone 2412 Corticosteroids 9451 0.26 0.52 0.12 -2.12
Salbutamol 299985 Selective beta(2)-agonists 351499 0.85 0.90 0.02 -2.04
Salbutamol 100micrograms/dose inhaler : 4
Salbutamol 100micrograms/dose inhaler CFC free : 240982
Salbutamol 200micrograms/dose dry powder inhaler : 817
Salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials : 3230
Salbutamol 2mg tablets : 54
Salbutamol 4mg tablets : 9
Salbutamol 5mg/ml nebuliser liquid : 34
Salbutamol 5mg/5ml solution for infusion ampoules : 4
Salbutamol 5mg/2.5ml nebuliser liquid unit dose vials : 2209
Salbutamol 2mg/5ml oral solution sugar free : 76
Salbutamol 100micrograms/dose breath actuated inh CFC free : 11846
Salbutamol 100micrograms/dose dry powder inhaler : 87
Salbutamol 100micrograms/dose dry pdr inhalation cartridge : 1
Ventolin 200micrograms/dose Accuhaler : 2405
Ventolin 100micrograms/dose Evohaler : 20250
Ventolin 2mg/5ml syrup : 3
Ventolin 2.5mg Nebules : 1280
Ventolin 5mg Nebules : 214
Salamol 100micrograms/dose inhaler CFC free (Teva) : 6285
Salamol 100micrograms/dose Easi-Breathe inhaler : 5234
Airomir 100micrograms/dose inhaler : 21
Airomir 100micrograms/dose Autohaler : 547
Salbutamol 5mg/2.5ml neb liq unit dose Steripoule vials : 1
Easyhaler Salbutamol sulfate 100micrograms/dose dry pdr inh : 3882
Easyhaler Salbutamol sulfate 200micrograms/dose dry pdr inh : 488
Salbulin Novolizer 100micrograms/dose inhalation powder : 14
Salbulin Novolizer 100micrograms/dose inhalation pdr refill : 8