Static outliers for The Roseberry 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 The Roseberry Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Doxycycline hyclate☰	4	Drugs for oral ulceration and inflammation	9	0.44	0.00	0.02	21.59
Doxycycline 20mg tablets : 4
Benzydamine hydrochloride☰	1	Rubefacients, topical NSAIDS, capsaicin and poultice	194	0.01	0.00	0.00	4.56
Difflam 3% cream : 1
Gluten free/low protein grains/flours☰	6	Foods for special diets	244	0.02	0.00	0.01	3.97
Promin low protein imitation rice pudding 69g sach : 3 Mevalia low protein rice replacer : 3
Medroxyprogesterone acetate☰	12	Progestogens and progesterone receptor modulators	17	0.71	0.15	0.15	3.74
Provera 10mg tablets : 7 Medroxyprogesterone 10mg tablets : 5
Salmeterol☰	74	Selective beta(2)-agonists	1552	0.05	0.01	0.01	3.30
Salmeterol 25micrograms/dose inhaler CFC free : 46 Salmeterol 50micrograms/dose dry powder inhaler : 14 Soltel 25micrograms/dose inhaler CFC free : 4 Serevent 25micrograms/dose Evohaler : 10

Prescribing where The Roseberry Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Folic acid☰	182	Drugs used in megaloblastic anaemias	641	0.28	0.70	0.16	-2.62
Folic acid 5mg tablets : 173 Folic acid 2.5mg/5ml oral solution sugar free : 1 Folic acid 5mg/5ml oral solution sugar free : 3 Folic acid 400microgram tablets : 5
Zopiclone☰	33	Hypnotics	131	0.25	0.60	0.14	-2.51
Zopiclone 7.5mg tablets : 12 Zopiclone 3.75mg tablets : 21
Senna☰	128	Stimulant laxatives	615	0.21	0.55	0.14	-2.48
Senna 7.5mg tablets : 120 Senna 7.5mg/5ml oral solution sugar free : 3 Manevac granules : 5
Progesterone☰	0	Progestogens and progesterone receptor modulators	17	0.00	0.48	0.27	-1.76
Tamsulosin hydrochloride☰	516	Drugs for urinary retention	636	0.81	0.92	0.06	-1.75
Tamsulosin 400microgram modified-release capsules : 516