Static outliers for Howden Medical Practice

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 Howden Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Guanfacine☰	9	CNS Stimulants and drugs used for ADHD	22	0.41	0.02	0.05	7.65
Intuniv 2mg modified-release tablets : 4 Intuniv 1mg modified-release tablets : 5
Timolol☰	32	Beta-adrenoceptor blocking drugs	3197	0.01	0.00	0.00	6.89
Timolol 10mg tablets : 32
Rupatadine fumarate☰	6	Antihistamines	1003	0.01	0.00	0.00	6.66
Rupatadine 10mg tablets : 6
Rabeprazole sodium☰	190	Proton pump inhibitors	5438	0.03	0.00	0.01	4.66
Rabeprazole 10mg gastro-resistant tablets : 41 Rabeprazole 20mg gastro-resistant tablets : 149
Perampanel☰	26	Control of epilepsy	1516	0.02	0.00	0.00	4.16
Perampanel 6mg tablets : 21 Perampanel 12mg tablets : 5

Prescribing where Howden Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Vitamin A☰	0	Vitamin A	2	0.00	0.84	0.35	-2.42
Neomycin sulfate☰	15	Nasal preparations for infection	27	0.56	0.84	0.14	-1.98
Naseptin nasal cream : 3 Neomycin 0.5% / Chlorhexidine hydrochloride 0.1% cream : 12
Sertraline hydrochloride☰	874	Selective serotonin re-uptake inhibitors	2996	0.29	0.45	0.09	-1.83
Sertraline 50mg tablets : 527 Sertraline 100mg tablets : 345 Sertraline 25mg tablets : 2
Miconazole nitrate☰	4	Antifungal preparations	74	0.05	0.27	0.14	-1.60
Miconazole 2% cream : 4
Furosemide☰	676	Loop diuretics	935	0.72	0.86	0.09	-1.49
Furosemide 20mg tablets : 204 Furosemide 40mg tablets : 467 Furosemide 20mg/5ml oral solution sugar free : 5