Static outliers for The Avenues Medical Centre

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 The Avenues Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Buserelin☰	1	Prostate cancer and gonadorelin analogues	58	0.02	0.00	0.00	70.93
Buserelin 100micrograms/dose nasal spray : 1
Timolol☰	42	Beta-adrenoceptor blocking drugs	2810	0.01	0.00	0.00	10.40
Timolol 10mg tablets : 42
Cefaclor☰	8	Cephalosporins	26	0.31	0.01	0.03	9.90
Cefaclor 375mg modified-release tablets : 8
Flavoxate hydrochloride☰	25	Drugs for urinary frequency enuresis and incontinence	526	0.05	0.00	0.01	8.01
Urispas 200 tablets : 1 Flavoxate 200mg tablets : 24
Carvedilol☰	293	Beta-adrenoceptor blocking drugs	2810	0.10	0.01	0.01	7.35
Carvedilol 12.5mg tablets : 92 Carvedilol 25mg tablets : 50 Carvedilol 3.125mg tablets : 70 Carvedilol 6.25mg tablets : 81

Prescribing where The Avenues Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cefalexin☰	3	Cephalosporins	26	0.12	0.96	0.10	-8.26
Cefalexin 250mg capsules : 2 Cefalexin 500mg capsules : 1
Doxazosin mesilate☰	365	Alpha-adrenoceptor blocking drugs	406	0.90	0.99	0.02	-4.64
Doxazosin 1mg tablets : 99 Doxazosin 2mg tablets : 85 Doxazosin 4mg tablets : 137 Doxazosin 8mg modified-release tablets : 22 Doxazosin 8mg tablets : 22
Naproxen☰	245	Non-steroidal anti-inflammatory drugs	682	0.36	0.69	0.10	-3.25
Naproxen 250mg tablets : 72 Naproxen 500mg tablets : 155 Naprosyn EC 250mg tablets : 1 Naproxen 500mg gastro-resistant tablets : 9 Naproxen 375mg gastro-resistant tablets : 3 Naproxen 250mg gastro-resistant tablets : 5
Chloramphenicol☰	35	Antibacterials	83	0.42	0.78	0.13	-2.77
Chloramphenicol 1% eye ointment : 29 Chloramphenicol 0.5% eye drops : 6
Furosemide☰	603	Loop diuretics	977	0.62	0.86	0.09	-2.67
Furosemide 20mg tablets : 449 Furosemide 40mg tablets : 138 Furosemide 20mg/5ml oral solution sugar free : 13 Furosemide 50mg/5ml oral solution sugar free : 3