Static outliers for Fell Cottage Surgery

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 Fell Cottage Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Glycopyrronium bromide☰	204	Antimuscarinic bronchodilators	311	0.66	0.06	0.10	5.88
Seebri Breezhaler 44microgram inhalation pdr caps with dev : 204
Ofloxacin☰	4	Quinolones	6	0.67	0.09	0.11	5.27
Ofloxacin 200mg tablets : 2 Ofloxacin 400mg tablets : 2
Dronedarone hydrochloride☰	7	Drugs for arrhythmias	25	0.28	0.02	0.06	4.17
Dronedarone 400mg tablets : 7
Etodolac☰	47	Non-steroidal anti-inflammatory drugs	674	0.07	0.01	0.02	4.14
Etodolac 600mg modified-release tablets : 47
Methenamine hippurate☰	62	Urinary-tract infections	227	0.27	0.03	0.06	3.94
Methenamine hippurate 1g tablets : 62

Prescribing where Fell Cottage Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nitrofurantoin☰	165	Urinary-tract infections	227	0.73	0.97	0.06	-3.94
Nitrofurantoin 100mg modified-release capsules : 158 Nitrofurantoin 50mg tablets : 7
Ciprofloxacin☰	2	Quinolones	6	0.33	0.86	0.15	-3.53
Ciprofloxacin 500mg tablets : 2
Co-codamol (Codeine phosphate/paracetamol)☰	98	Non-opioid analgesics and compound preparations	2520	0.04	0.45	0.15	-2.68
Co-codamol 8mg/500mg tablets : 77 Co-codamol 30mg/500mg effervescent tablets : 1 Co-codamol 8mg/500mg effervescent tablets : 9 Co-codamol 15mg/500mg tablets : 6 Co-codamol 8mg/500mg capsules : 5
Tiotropium bromide☰	80	Antimuscarinic bronchodilators	311	0.26	0.71	0.18	-2.48
Spiriva 18microgram inhalation powder capsules : 63 Braltus 10microgram inhalation pdr caps with Zonda inhaler : 2 Spiriva Respimat 2.5microg/dose inhalation soln : 15
Ramipril☰	847	Angiotensin-converting enzyme inhibitors	2924	0.29	0.69	0.17	-2.40
Ramipril 1.25mg capsules : 110 Ramipril 2.5mg capsules : 296 Ramipril 5mg capsules : 239 Ramipril 10mg capsules : 196 Ramipril 5mg tablets : 3 Ramipril 10mg tablets : 3