Static outliers for Cheviot 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 Cheviot Medical Group is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Acipimox☰	6	Lipid-regulating drugs	3015	0.00	0.00	0.00	15.93
Acipimox 250mg capsules : 6
Pioglitazone hydrochloride☰	110	Other antidiabetic drugs	183	0.60	0.05	0.05	10.57
Pioglitazone 45mg tablets : 61 Pioglitazone 30mg tablets : 28 Pioglitazone 15mg tablets : 21
Primidone☰	29	Control of epilepsy	615	0.05	0.00	0.01	7.03
Primidone 250mg tablets : 24 Primidone 50mg tablets : 5
Indometacin☰	47	Non-steroidal anti-inflammatory drugs	508	0.09	0.01	0.01	6.58
Indometacin 50mg capsules : 43 Indometacin 25mg capsules : 4
Estradiol and estriol with progestogen☰	4	Oestrogens and Hormone Replacement Therapy	109	0.04	0.00	0.01	5.63
Trisequens tablets : 4

Prescribing where Cheviot Medical Group is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Amlodipine☰	460	Calcium-channel blockers	1427	0.32	0.75	0.11	-3.81
Amlodipine 5mg tablets : 210 Amlodipine 10mg tablets : 247 Amlodipine 2.5mg tablets : 3
Mesalazine (Systemic)☰	22	Aminosalicylates	143	0.15	0.64	0.15	-3.30
Mesalazine 1g suppositories : 4 Octasa 400mg MR gastro-resistant tablets : 18
Fusidic acid☰	7	Antibacterial preparations also used systemically	25	0.28	0.72	0.15	-2.89
Fusidic acid 2% cream : 7
Amoxicillin☰	71	Broad-spectrum penicillins	126	0.56	0.81	0.09	-2.87
Amoxicillin 500mg capsules : 68 Amoxicillin 250mg/5ml oral suspension sugar free : 3
Aspirin☰	531	Antiplatelet drugs	1096	0.48	0.65	0.06	-2.78
Aspirin 75mg dispersible tablets : 377 Aspirin 75mg gastro-resistant tablets : 150 Aspirin 75mg tablets : 4