Static outliers for Priory 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 Priory Medical Group is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Asenapine☰	20	Drugs used for mania and hypomania	195	0.10	0.00	0.00	21.44
Asenapine 5mg sublingual tablets sugar free : 20
Amiloride hydrochloride with loop diuretics☰	4	Potassium sparing diuretics and compounds	4	1.00	0.02	0.08	11.95
Amiloride 5mg / Bumetanide 1mg tablets : 4
Eslicarbazepine acetate☰	138	Control of epilepsy	5563	0.02	0.00	0.00	8.83
Eslicarbazepine 800mg tablets : 71 Eslicarbazepine 200mg tablets : 67
Telmisartan☰	446	Angiotensin-II receptor antagonists	3024	0.15	0.01	0.02	5.89
Telmisartan 40mg tablets : 229 Telmisartan 80mg tablets : 85 Telmisartan 20mg tablets : 132
Methylcellulose☰	4	Bulk-forming laxatives	122	0.03	0.00	0.01	4.60
Methylcellulose 500mg tablets : 4

Prescribing where Priory Medical Group is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Aciclovir☰	111	Herpes simplex and varicella-zoster	157	0.71	0.95	0.07	-3.59
Aciclovir 400mg tablets : 51 Aciclovir 200mg/5ml oral suspension sugar free : 1 Aciclovir 800mg dispersible tablets : 1 Aciclovir 200mg tablets : 23 Aciclovir 800mg tablets : 25 Aciclovir 200mg dispersible tablets : 10
Clarithromycin☰	61	Macrolides	450	0.14	0.54	0.17	-2.43
Clarithromycin 500mg tablets : 51 Clarithromycin 250mg tablets : 2 Clarithromycin 125mg/5ml oral suspension : 3 Clarithromycin 250mg/5ml oral suspension : 5
Glycopyrronium bromide☰	0	Antimuscarinic drugs	6	0.00	0.82	0.36	-2.30
Aspirin☰	2874	Antiplatelet drugs	5592	0.51	0.65	0.06	-2.29
Aspirin 75mg dispersible tablets : 2149 Aspirin 75mg tablets : 310 Aspirin 75mg gastro-resistant tablets : 415
Other multivitamin preparations☰	40	Multivitamin preparations	114	0.35	0.81	0.21	-2.21
Dalivit oral drops : 2 Abidec Multivitamin drops : 2 Forceval capsules : 9 Renavit tablets : 22 Forceval Soluble tablets : 5