Static outliers for I J Healthcare

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 I J Healthcare is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ephedrine hydrochloride☰	1	Topical nasal decongestants	1	1.00	0.01	0.06	17.74
Ephedrine 0.5% nasal drops : 1
Tryptophan☰	8	Other antidepressant drugs	1257	0.01	0.00	0.00	16.96
Optimax 500mg capsules : 8
Solifenacin/tamsulosin☰	54	Drugs for urinary retention	334	0.16	0.01	0.02	10.27
Vesomni 6mg/0.4mg modified-release tablets : 28 Solifenacin 6mg / Tamsulosin 400microgram MR tab : 26
Dicycloverine hydrochloride☰	49	Antispasmodic and other drugs altering gut motility	343	0.14	0.01	0.01	10.14
Dicycloverine 10mg tablets : 49
Cariprazine☰	4	Antipsychotic drugs	507	0.01	0.00	0.00	9.00
Cariprazine 3mg capsules : 4

Prescribing where I J Healthcare is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nitrofurantoin☰	117	Urinary-tract infections	169	0.69	0.97	0.06	-4.51
Nitrofurantoin 100mg modified-release capsules : 95 Nitrofurantoin 50mg tablets : 17 Nitrofurantoin 100mg tablets : 5
Tamsulosin hydrochloride☰	241	Drugs for urinary retention	334	0.72	0.92	0.06	-3.24
Tamsulosin 400microgram modified-release capsules : 237 Tamsulosin 400microgram modified-release tablets : 4
Trimethoprim☰	30	Sulfonamides and trimethoprim	59	0.51	0.86	0.13	-2.75
Trimethoprim 50mg/5ml oral suspension sugar free : 1 Trimethoprim 200mg tablets : 18 Trimethoprim 100mg tablets : 11
Ivermectin☰	1	Topical preparation for rosacea	3	0.33	0.88	0.24	-2.30
Ivermectin 10mg/g cream : 1
Finasteride☰	83	Male sex hormones and antagonists	149	0.56	0.82	0.12	-2.27
Finasteride 5mg tablets : 83