Static outliers for Dalton Terrace 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 Dalton Terrace Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Paraffin soft yellow	3	Emollients	196	0.02	0.00	0.00	8.45
Yellow soft paraffin solid : 3
Lercanidipine hydrochloride	1101	Calcium-channel blockers	2426	0.45	0.06	0.07	5.43
Lercanidipine 10mg tablets : 525 Lercanidipine 20mg tablets : 576
Levofloxacin	13	Quinolones	26	0.50	0.05	0.09	5.09
Levofloxacin 250mg tablets : 3 Levofloxacin 500mg tablets : 10
Zonisamide	52	Control of epilepsy	1245	0.04	0.01	0.01	4.39
Zonisamide 25mg capsules : 4 Zonisamide 100mg capsules : 24 Zonisamide 50mg capsules : 24
Flubiprofen	1	Drugs for oral ulceration and inflammation	17	0.06	0.00	0.01	4.37
Flurbiprofen 8.75mg lozenges : 1

Prescribing where Dalton Terrace Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Ivermectin	0	Topical preparation for rosacea	2	0.00	0.88	0.24	-3.72

Amlodipine	927	Calcium-channel blockers	2426	0.38	0.75	0.11	-3.28
Amlodipine 5mg tablets : 482 Amlodipine 10mg tablets : 435 Amlodipine 2.5mg tablets : 10
Ciprofloxacin	12	Quinolones	26	0.46	0.86	0.15	-2.67
Ciprofloxacin 250mg tablets : 1 Ciprofloxacin 750mg tablets : 1 Ciprofloxacin 500mg tablets : 10
Aspirin	711	Antiplatelet drugs	1391	0.51	0.65	0.06	-2.33
Aspirin 75mg dispersible tablets : 627 Aspirin 75mg gastro-resistant tablets : 59 Aspirin 75mg tablets : 25
Other multivitamin preparations	18	Multivitamin preparations	54	0.33	0.81	0.21	-2.29
Dalivit oral drops : 2 Abidec Multivitamin drops : 2 Forceval capsules : 9 Paravit-cf capsules : 5