Static outliers for Parklands 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 Parklands Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other shampoo and scalp preparations☰	2	Shampoos and some other scalp preparations	266	0.01	0.00	0.00	21.74
Camphor 3.57%/Salicylic acid 3.57%/Phenol 2.85%/Sulfur 2.14% : 2
Phosphates☰	1	Bowel cleansing preparations	1	1.00	0.01	0.07	14.58
Phospho-soda 24.4g/10.8g oral solution : 1
Tacalcitol☰	24	Preparations for psoriasis	119	0.20	0.00	0.02	11.79
Tacalcitol 4micrograms/g ointment : 9 Curatoderm 4micrograms/g ointment : 15
Glimepiride☰	1094	Sulfonylureas	1191	0.92	0.07	0.13	6.32
Glimepiride 2mg tablets : 185 Glimepiride 1mg tablets : 286 Glimepiride 3mg tablets : 97 Glimepiride 4mg tablets : 526
Penicillamine☰	15	Rheumatic disease suppressant drugs	262	0.06	0.00	0.01	6.26
Penicillamine 125mg tablets : 10 Penicillamine 250mg tablets : 5

Prescribing where Parklands Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gliclazide☰	91	Sulfonylureas	1191	0.08	0.92	0.14	-6.26
Gliclazide 80mg tablets : 36 Gliclazide 40mg tablets : 51 Gliclazide 30mg modified-release tablets : 4
Alendronic acid☰	211	Bisphosphonates and other drugs	573	0.37	0.87	0.09	-5.45
Alendronic acid 70mg tablets : 195 Alendronic acid 70mg/100ml soln unit dose sugar free : 6 Alendronic acid 70mg effervescent tablets sugar free : 5 Binosto 70mg effervescent tablets : 5
Betamethasone valerate☰	121	Topical corticosteroids	1196	0.10	0.28	0.07	-2.63
Betamethasone valerate 0.1% scalp application : 37 Betamethasone valerate 0.025% ointment : 1 Betamethasone valerate 0.1% lotion : 1 Betamethasone valerate 0.1% / Clioquinol 3% ointment : 1 Betnovate 0.1% scalp application : 1 Betnovate 0.1% cream : 9 Betamethasone valerate 0.1% ointment : 8 Betnovate 0.1% ointment : 3 Betacap 0.1% scalp application : 12 Bettamousse 0.1% cutaneous foam : 7 Fucibet cream : 21 Betamethasone valerate 0.1% cream : 10 Betamethasone valerate 0.025% cream : 5 Betamethasone valerate 0.1% / Fusidic acid 2% cream : 5
Cefalexin☰	24	Cephalosporins	34	0.71	0.96	0.10	-2.48
Cefalexin 250mg/5ml oral suspension : 2 Cefalexin 500mg tablets : 2 Cefalexin 125mg/5ml oral suspension sugar free : 1 Cefalexin 500mg capsules : 9 Cefalexin 250mg/5ml oral suspension sugar free : 4 Cefalexin 250mg capsules : 3 Cefalexin 125mg/5ml oral suspension : 3
Calcipotriol☰	80	Preparations for psoriasis	119	0.67	0.87	0.08	-2.41
Calcipotriol 0.005% / Betamethasone dipropionate 0.05% gel : 1 Dovonex 50micrograms/g ointment : 1 Dovobet ointment : 1 Calcipotriol 50micrograms/ml scalp solution : 3 Calcipotriol 0.005% / Betamethasone dipropionate 0.05% oint : 12 Dovobet gel : 21 Calcipotriol 50microg/Betamethasone diprop 500microg/g foam : 11 Enstilar 50micrograms/g / 0.5 mg/g cutaneous foam : 25 Calcipotriol 50micrograms/g ointment : 5