Static outliers for Marsh House Medical 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 Marsh House Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Mometasone/glycoyrronium/indacaterol☰	2	Corticosteroids (respiratory)	1749	0.00	0.00	0.00	8.05
Enerzair Breezhaler 114microg / 46microg / 136microg/dose : 2
Exenatide☰	49	Other antidiabetic drugs	656	0.07	0.01	0.01	7.27
Exenatide 2mg inj pre-filled disposable devices : 2 Bydureon 2mg inj pre-filled pens : 14 Bydureon BCise 2mg/0.85ml prolonged-release inj pf pens : 18 Byetta 10micrograms/0.04ml inj 2.4ml pre-filled pens : 3 Exenatide 2mg/0.85ml prolonged-release inj pf dispos dev : 12
Sulindac☰	4	Non-steroidal anti-inflammatory drugs	844	0.00	0.00	0.00	5.20
Sulindac 200mg tablets : 4
Darifenacin hydrobromide☰	97	Drugs for urinary frequency enuresis and incontinence	597	0.16	0.01	0.04	4.08
Darifenacin 7.5mg modified-release tablets : 59 Darifenacin 15mg modified-release tablets : 38
Promethazine teoclate☰	38	Drugs used in nausea and vertigo	600	0.06	0.00	0.01	4.04
Promethazine teoclate 25mg tablets : 38

Prescribing where Marsh House Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Folic acid☰	172	Drugs used in megaloblastic anaemias	962	0.18	0.70	0.16	-3.28
Folic acid 5mg tablets : 163 Folic acid 2.5mg/5ml oral solution sugar free : 2 Folic acid 400microgram tablets : 7
Urea hydrogen peroxide☰	0	Removal of ear wax and other substances	1	0.00	0.83	0.34	-2.47
Glycopyrronium bromide☰	0	Antimuscarinic drugs	2	0.00	0.82	0.36	-2.30
Famotidine☰	10	H2-Receptor antagonists	27	0.37	0.78	0.23	-1.76
Famotidine 40mg tablets : 3 Famotidine 20mg tablets : 7
Tadalafil☰	11	Drugs for erectile dysfunction	238	0.05	0.19	0.09	-1.68
Tadalafil 10mg tablets : 3 Tadalafil 20mg tablets : 3 Tadalafil 5mg tablets : 5