Static outliers for Topcliffe Surgery

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 Topcliffe Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Nicotinamide	5	Topical preparations for acne	27	0.19	0.00	0.01	25.32
Nicotinamide 4% gel : 5
Diclofenac sodium	22	Rubefacients, topical NSAIDS, capsaicin and poultice	93	0.24	0.00	0.01	22.13
Diclofenac sodium 1% gel : 22
Gluten free/low protein pasta	17	Foods for special diets	86	0.20	0.00	0.02	10.97
Promin low protein pasta spirals : 2 Promin low protein pasta shells : 1 Promin low protein pasta flat noodles : 1 Mevalia low protein penne : 1 Promin Plus low protein pasta flat noodles : 3 Promin Plus low protein pasta macaroni : 3 Promin Plus low protein pasta spaghetti : 6
Gluten free/low protein bread	16	Foods for special diets	86	0.19	0.01	0.02	8.55
Mevalia low protein mini baguette : 4 Mevalia low protein ciabattine : 6 Mevalia low protein pizza base : 6
Gluten free/low protein grains/flours	4	Foods for special diets	86	0.05	0.00	0.01	7.67
Promin low protein imitation rice : 1 Mevalia low protein rice replacer : 3

Prescribing where Topcliffe Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Procyclidine hydrochloride	0	Antimuscarinic drugs used in parkinsonism	4	0.00	0.84	0.21	-4.04

Other emollient preparations	41	Emollients	66	0.62	0.89	0.07	-3.83
Diprobase ointment : 1 Oilatum cream : 1 Doublebase gel : 3 Dermol 500 lotion : 21 Dermol cream : 15
Famotidine	0	H2-Receptor antagonists	3	0.00	0.78	0.23	-3.34

Carbimazole	3	Antithyroid drugs	5	0.60	0.93	0.11	-3.12
Carbimazole 20mg tablets : 3
Neomycin sulfate	2	Nasal preparations for infection	4	0.50	0.84	0.14	-2.37
Naseptin nasal cream : 2