Static outliers for Helmsley 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 Helmsley Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Olmesartan medoxomil☰	662	Angiotensin-II receptor antagonists	1494	0.44	0.02	0.03	12.53
Olmesartan medoxomil 10mg tablets : 227 Olmesartan medoxomil 20mg tablets : 270 Olmesartan medoxomil 40mg tablets : 165
Diazoxide☰	1	Treatment of hypoglycaemia	3	0.33	0.00	0.04	9.15
Diazoxide 50mg tablets : 1
Azelaic acid☰	7	Topical preparations for acne	13	0.54	0.07	0.06	7.84
Finacea 15% gel : 1 Azelaic acid 20% cream : 6
Gluten free/low protein mixes☰	3	Foods for special diets	77	0.04	0.00	0.01	6.56
Mevalia low protein bread mix : 3
Phased formulations of ethinylestradiol☰	16	Combined hormonal contraceptives	147	0.11	0.01	0.02	6.12
TriRegol tablets : 9 Logynon tablets : 7

Prescribing where Helmsley Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Combined ethinylestradiol 30mcg☰	90	Combined hormonal contraceptives	147	0.61	0.81	0.07	-2.67
Rigevidon tablets : 38 Maexeni 150microgram/30microgram tablets : 2 Lucette 0.03mg/3mg tablets : 1 Gedarel 30microgram/150microgram tablets : 9 Yacella 0.03mg/3mg tablets : 9 Levest 150/30 tablets (Morningside) : 23 Yasmin tablets : 8
Calcium carbonate☰	8	Calcium supplements	13	0.62	0.95	0.13	-2.52
Calcichew 500mg chewable tablets : 2 Adcal 1500mg chewable tablets : 6
Tiotropium bromide☰	26	Antimuscarinic bronchodilators	103	0.25	0.71	0.18	-2.50
Tiotropium bromide 10microgram inhalation pdr caps with dev : 1 Tiotropium bromide 18microgram inhalation powder capsules : 13 Spiriva Respimat 2.5microg/dose inhalation soln : 7 Spiriva Respimat 2.5microg/dose inhalation soln refill cart : 5
Quetiapine☰	15	Antipsychotic drugs	349	0.04	0.35	0.12	-2.48
Quetiapine 25mg tablets : 4 Biquelle XL 50mg tablets : 6 Quetiapine 150mg tablets : 5
Urea hydrogen peroxide☰	0	Removal of ear wax and other substances	1	0.00	0.83	0.34	-2.47