Static outliers for Chadwick Practice

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 Chadwick Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Buserelin☰	5	Prostate cancer and gonadorelin analogues	65	0.08	0.00	0.00	316.54
Buserelin 100micrograms/dose nasal spray : 5
Lidocaine hydrochloride☰	16	Drugs for oral ulceration and inflammation	49	0.33	0.01	0.04	7.80
Dentinox teething gel : 16
Dequalinium chloride☰	1	Vaginal and vulval infections	30	0.03	0.00	0.01	5.74
Fluomizin 10mg vaginal tablets : 1
Buspirone hydrochloride☰	214	Anxiolytics	545	0.39	0.03	0.06	5.66
Buspirone 5mg tablets : 108 Buspirone 10mg tablets : 106
Bupropion hydrochloride☰	4	Nicotine dependence	4	1.00	0.10	0.20	4.47
Bupropion 150mg modified-release tablets : 4

Prescribing where Chadwick Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Diazepam☰	160	Anxiolytics	545	0.29	0.75	0.14	-3.39
Diazepam 2mg tablets : 149 Diazepam 5mg tablets : 11
Folic acid☰	271	Drugs used in megaloblastic anaemias	1354	0.20	0.70	0.16	-3.15
Folic acid 5mg tablets : 231 Folic acid 400microgram tablets : 35 Folic acid 2.5mg/5ml oral solution sugar free : 5
Clarithromycin☰	57	Macrolides	376	0.15	0.54	0.17	-2.33
Clarithromycin 500mg tablets : 48 Clarithromycin 250mg tablets : 2 Clarithromycin 250mg/5ml oral suspension : 4 Clarithromycin 125mg/5ml oral suspension : 3
Other multivitamin preparations☰	24	Multivitamin preparations	67	0.36	0.81	0.21	-2.18
Ketovite liquid : 1 Forceval Soluble tablets : 4 Abidec Multivitamin drops : 13 Forceval capsules : 6
Lactulose☰	78	Osmotic laxatives	907	0.09	0.28	0.10	-2.00
Lactulose 3.1-3.7g/5ml oral solution : 75 Lactulose 10g/15ml oral solution 15ml sachets sugar free : 3