Static outliers for The Gables Medical Group

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 Gables Medical Group is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Clemastine fumarate☰	3	Antihistamines	577	0.01	0.00	0.00	10.36
Clemastine 1mg tablets : 3
Pioglitazone hydrochloride☰	132	Other antidiabetic drugs	316	0.42	0.05	0.05	7.08
Pioglitazone 15mg tablets : 46 Pioglitazone 30mg tablets : 31 Pioglitazone 45mg tablets : 55
Deflazacort☰	11	Use of corticosteroids	435	0.03	0.00	0.00	7.07
Deflazacort 6mg tablets : 11
Dronedarone hydrochloride☰	6	Drugs for arrhythmias	14	0.43	0.02	0.06	6.55
Dronedarone 400mg tablets : 6
Antazoline☰	6	Other anti-inflammatory preparations	37	0.16	0.01	0.03	5.41
Antazoline 0.5% / Xylometazoline 0.05% eye drops : 6

Prescribing where The Gables Medical Group is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Tiotropium bromide☰	47	Antimuscarinic bronchodilators	255	0.18	0.71	0.18	-2.88
Spiriva Respimat 2.5microg/dose inhalation soln : 29 Spiriva Respimat 2.5microg/dose inhalation soln refill cart : 1 Spiriva 18microgram inhalation pdr caps with HandiHaler : 8 Braltus 10microgram inhalation pdr caps with Zonda inhaler : 3 Tiotropium bromide 18microgram inhalation powder capsules : 6
Co-codamol (Codeine phosphate/paracetamol)☰	28	Non-opioid analgesics and compound preparations	2029	0.01	0.45	0.15	-2.84
Co-codamol 8mg/500mg capsules : 1 Co-codamol 30mg/500mg effervescent tablets : 1 Co-codamol 8mg/500mg tablets : 26
Clarithromycin☰	29	Macrolides	214	0.14	0.54	0.17	-2.43
Clarithromycin 250mg tablets : 4 Clarithromycin 125mg/5ml oral suspension : 3 Clarithromycin 250mg/5ml oral suspension : 3 Clarithromycin 500mg tablets : 19
Zopiclone☰	88	Hypnotics	317	0.28	0.60	0.14	-2.32
Zopiclone 7.5mg tablets : 38 Zopiclone 3.75mg tablets : 50
Aspirin☰	1061	Antiplatelet drugs	2057	0.52	0.65	0.06	-2.26
Aspirin 75mg dispersible tablets : 1002 Aspirin 75mg gastro-resistant tablets : 50 Aspirin 75mg tablets : 9