Static outliers for Colne Valley 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 Colne Valley Group Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Benzocaine☰	1	Topical local anaesthetics and antipruritics	15	0.07	0.0	0.00	15.44
Benzocaine 3% cream : 1
Low protein meals☰	5	Foods for special diets	58	0.09	0.0	0.01	10.53
Promin low protein pasta in sauce 72g sach : 2 Promin low protein pasta in sauce 66g sach cheese & broccoli : 3
Oxycodone hydrochloride/naloxone hydrochloride☰	98	Opioid analgesics	2314	0.04	0.0	0.01	8.07
Oxycodone 10mg / Naloxone 5mg modified-release tablets : 44 Oxycodone 5mg / Naloxone 2.5mg modified-release tablets : 40 Oxycodone 40mg / Naloxone 20mg modified-release tablets : 9 Oxycodone 20mg / Naloxone 10mg modified-release tablets : 5
Aceclofenac☰	21	Non-steroidal anti-inflammatory drugs	1274	0.02	0.0	0.00	6.69
Aceclofenac 100mg tablets : 21
Chlorothiazide☰	9	Thiazides and related diuretics	1107	0.01	0.0	0.00	5.29
Chlorothiazide 250mg/5ml oral suspension : 9

Prescribing where Colne Valley Group Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	43	Skeletal muscle relaxants	150	0.29	0.83	0.18	-2.93
Baclofen 10mg tablets : 39 Baclofen 5mg/5ml oral solution sugar free : 4
Zinc oxide☰	0	Soothing haemorrhoidal preparations	6	0.00	0.77	0.27	-2.89
Amitriptyline hydrochloride☰	924	Tricyclic and related antidepressant drugs	1338	0.69	0.84	0.08	-1.95
Amitriptyline 10mg tablets : 627 Amitriptyline 25mg tablets : 107 Amitriptyline 50mg tablets : 189 Amitriptyline 10mg/5ml oral solution sugar free : 1
Permethrin☰	3	Parasiticidal preparations	7	0.43	0.84	0.25	-1.63
Permethrin 5% cream : 3
Ganciclovir☰	0	Antivirals	1	0.00	0.68	0.42	-1.60