Static outliers for Healds Road 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 Healds Road Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ergotamine tartrate☰	3	Treatment of acute migraine	244	0.01	0.00	0.00	99.83
Migril tablets : 3
Sodium clodronate☰	7	Bisphosphonates and other drugs	170	0.04	0.00	0.01	7.89
Sodium clodronate 800mg tablets : 1 Clasteon 400mg capsules : 6
Eprosartan☰	77	Angiotensin-II receptor antagonists	1886	0.04	0.00	0.01	6.88
Eprosartan 300mg tablets : 34 Eprosartan 600mg tablets : 43
Betamethasone sodium phosphate☰	35	Use of corticosteroids	564	0.06	0.01	0.01	5.21
Betamethasone 500microgram soluble tablets sugar free : 35
Phentolamine/aviptadil☰	7	Drugs for erectile dysfunction	319	0.02	0.00	0.00	4.98
Invicorp 25micrograms/2mg/0.35ml inj : 7

Prescribing where Healds Road Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbocisteine☰	65	Mucolytics	98	0.66	0.97	0.08	-3.83
Carbocisteine 375mg capsules : 54 Carbocisteine 750mg/5ml oral solution sugar free : 1 Mucodyne 250mg/5ml syrup : 1 Carbocisteine 250mg/5ml oral solution : 9
Tamsulosin hydrochloride☰	238	Drugs for urinary retention	341	0.70	0.92	0.06	-3.63
Tamsulosin 400microgram modified-release capsules : 180 Tamsulosin 400microgram modified-release tablets : 58
Desogestrel☰	99	Oral progestogen-only contraceptives	132	0.75	0.94	0.05	-3.47
Desogestrel 75microgram tablets : 56 Cerelle 75microgram tablets : 41 Cerazette 75microgram tablets : 2
Prednisolone☰	386	Use of corticosteroids	564	0.68	0.88	0.06	-3.10
Prednisolone 5mg tablets : 249 Prednisolone 5mg gastro-resistant tablets : 43 Prednisolone 5mg soluble tablets : 42 Prednisolone 1mg gastro-resistant tablets : 2 Prednisolone 1mg tablets : 25 Prednisolone 2.5mg gastro-resistant tablets : 25
Azathioprine☰	60	Antiproliferative immunosuppressants	190	0.32	0.80	0.19	-2.63
Azathioprine 50mg tablets : 45 Azathioprine 25mg tablets : 15