Static outliers for Martonside Medical Centre

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 Martonside Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Shingles (H/Z)☰	20	Vaccines and antisera	44	0.45	0.01	0.06	7.62
Zostavax vacc inj 0.65ml pfs : 20
Nadolol☰	21	Beta-adrenoceptor blocking drugs	3445	0.01	0.00	0.00	5.93
Nadolol 80mg tablets : 21
Paracetamol and caffeine☰	1	Non-opioid analgesics and compound preparations	2780	0.00	0.00	0.00	5.72
Paracetamol 500mg / Caffeine 65mg efferv tab sugar free : 1
Alverine citrate/simeticone☰	2	Antispasmodic and other drugs altering gut motility	474	0.00	0.00	0.00	5.71
Alverine 60mg / Simeticone 300mg capsules : 2
Hydromorphone hydrochloride☰	19	Opioid analgesics	2649	0.01	0.00	0.00	5.57
Hydromorphone 24mg modified-release capsules : 7 Hydromorphone 8mg modified-release capsules : 7 Hydromorphone 4mg modified-release capsules : 5

Prescribing where Martonside Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Insulin aspart☰	59	Short-acting insulins	122	0.48	0.79	0.12	-2.63
NovoRapid Penfill 100units/ml inj 3ml cartridges : 29 NovoRapid PumpCart 100units/ml inj 1.6ml cartridges : 1 NovoRapid 100units/ml solution for injection 10ml vials : 10 NovoRapid FlexPen 100units/ml inj 3ml pre-filled pens : 19
Prucalopride☰	0	Other drugs used in constipation	5	0.00	0.71	0.33	-2.18
Citalopram hydrobromide☰	584	Selective serotonin re-uptake inhibitors	3696	0.16	0.32	0.08	-1.93
Citalopram 20mg tablets : 287 Citalopram 10mg tablets : 139 Citalopram 40mg tablets : 158
Moxonidine☰	0	Centrally-acting antihypertensive drugs	8	0.00	0.64	0.34	-1.92
Methylprednisolone acetate☰	0	Local corticosteroid injections	3	0.00	0.73	0.39	-1.87