Static outliers for Todmorden Group 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 Todmorden Group Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Indacaterol maleate 43 Selective beta(2)-agonists 3014 0.01 0.00 0.00 7.61
Magnesium trisilicate 2 Antacids and simeticone 3 0.67 0.03 0.14 4.67
Alogliptin/metformin 164 Other antidiabetic drugs 1882 0.09 0.00 0.02 4.51
Metformin hydrochloride/pioglitazone 41 Other antidiabetic drugs 1882 0.02 0.00 0.00 4.50
Lixisenatide 52 Other antidiabetic drugs 1882 0.03 0.00 0.01 4.16

Prescribing where Todmorden Group Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Gliclazide 313 Sulfonylureas 591 0.53 0.92 0.14 -2.91
Combined ethinylestradiol 30mcg 121 Combined hormonal contraceptives 199 0.61 0.81 0.07 -2.72
Folic acid 521 Drugs used in megaloblastic anaemias 1472 0.35 0.70 0.16 -2.17
Baclofen 153 Skeletal muscle relaxants 348 0.44 0.83 0.18 -2.10
Amitriptyline hydrochloride 1002 Tricyclic and related antidepressant drugs 1473 0.68 0.84 0.08 -2.09