Static outliers for Bridge Medical

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 Bridge Medical is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Chlordiazepoxide hydrochloride☰	18	Anxiolytics	119	0.15	0.01	0.02	9.38
Chlordiazepoxide 5mg capsules : 18
Phentolamine/aviptadil☰	5	Drugs for erectile dysfunction	136	0.04	0.00	0.00	8.53
Phentolamine 2mg/0.35ml / Aviptadil 25microg/0.35ml inj amp : 5
Nabumetone☰	24	Non-steroidal anti-inflammatory drugs	564	0.04	0.00	0.01	7.94
Nabumetone 500mg tablets : 24
Doxycycline hyclate☰	2	Drugs for oral ulceration and inflammation	13	0.15	0.00	0.02	7.37
Doxycycline 20mg tablets : 2
Sodium citrate (Rectal)☰	15	Osmotic laxatives	221	0.07	0.01	0.01	6.25
Micralax Micro-enema 5ml : 15

Prescribing where Bridge Medical is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Trimethoprim☰	42	Sulfonamides and trimethoprim	93	0.45	0.86	0.13	-3.19
Trimethoprim 100mg tablets : 12 Trimethoprim 200mg tablets : 20 Trimethoprim 50mg/5ml oral suspension sugar free : 10
Doxazosin mesilate☰	264	Alpha-adrenoceptor blocking drugs	284	0.93	0.99	0.02	-3.09
Doxazosin 1mg tablets : 68 Doxazosin 2mg tablets : 100 Doxazosin 4mg tablets : 93 Doxazosin 8mg tablets : 3
Estradiol☰	7	Oestrogens and Hormone Replacement Therapy	92	0.08	0.46	0.14	-2.73
Estradiol 0.06% gel (750microgram per actuation) : 2 Estradiol 2mg tablets : 1 Evorel 75 patches : 1 Estradiol 1mg tablets : 3
Chloramphenicol☰	6	Antibacterials	14	0.43	0.78	0.13	-2.71
Chloramphenicol 1% eye ointment : 1 Chloramphenicol 0.5% eye dps 0.5ml ud preservative free : 1 Chloramphenicol 0.5% eye drops : 4
Glycopyrronium bromide☰	0	Antimuscarinic drugs	1	0.00	0.82	0.36	-2.30