Static outliers for NHS Surrey Heartlands CCG

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 NHS Surrey Heartlands CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Sulfapyridine 2 Sulfonamides and trimethoprim 10004 0.00 0.0 0.00 9.46
Betamethasone 2 Use of corticosteroids 41870 0.00 0.0 0.00 9.16
Sucrase 2 Drugs used in metabolic disorders 14 0.14 0.0 0.02 9.06
Aminophylline 11 Theophylline 2893 0.00 0.0 0.00 7.78
Pindolol 5 Beta-adrenoceptor blocking drugs 213699 0.00 0.0 0.00 7.42

Prescribing where NHS Surrey Heartlands CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Solifenacin 6217 Drugs for urinary frequency enuresis and incontinence 37410 0.17 0.33 0.06 -2.51
Sulfasalazine 3052 Aminosalicylates 14196 0.21 0.35 0.06 -2.15
Gabapentin 23802 Control of epilepsy 149110 0.16 0.25 0.04 -2.08
Apixaban 27655 Oral anticoagulants 125331 0.22 0.42 0.11 -1.84
Medroxyprogesterone acetate 3005 Parenteral progestogen-only contraceptives 3925 0.77 0.89 0.07 -1.78