Static outliers for The Dekeyser 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 The Dekeyser Group Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gluten free/low protein drink☰	5	Foods for special diets	180	0.03	0.0	0.00	19.33
Mevalia Lattis low protein drink : 5
Granisetron hydrochloride☰	4	Drugs used in nausea and vertigo	783	0.01	0.0	0.00	7.96
Granisetron 1mg/1ml solution for injection ampoules : 4
Apomorphine hydrochloride hemihydrate☰	6	Dopaminergic drugs used in parkinsonism	510	0.01	0.0	0.00	7.83
Dacepton 100mg/20ml solution for infusion vials : 6
Gluten free/low protein cereals☰	5	Foods for special diets	180	0.03	0.0	0.01	5.17
Promin low protein hot breakfast powder 57g sach chocolate : 5
Gluten free/low protein biscuits☰	9	Foods for special diets	180	0.05	0.0	0.01	4.32
Mevalia low protein frollini biscuits : 4 Mevalia low protein fruit bar : 5

Prescribing where The Dekeyser Group Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cefalexin☰	69	Cephalosporins	106	0.65	0.96	0.10	-3.02
Cefalexin 250mg/5ml oral suspension : 2 Cefalexin 250mg/5ml oral suspension sugar free : 1 Cefalexin 500mg capsules : 23 Cefalexin 250mg tablets : 4 Cefalexin 125mg/5ml oral suspension : 8 Cefalexin 250mg capsules : 21 Cefalexin 125mg/5ml oral suspension sugar free : 10
Acamprosate calcium☰	17	Alcohol dependence	57	0.30	0.83	0.31	-1.73
Acamprosate 333mg gastro-resistant tablets : 17
Glyceryl trinitrate☰	72	Nitrates	719	0.10	0.26	0.10	-1.59
Glyceryl trinitrate 400micrograms/dose pump sublingual spray : 70 Glyceryl trinitrate 500microgram sublingual tablets : 1 Glyceryl trinitrate 5mg/24hours transdermal patches : 1
Spironolactone☰	258	Potassium-sparing diuretics and aldosterone antagonists	506	0.51	0.72	0.14	-1.52
Spironolactone 25mg tablets : 221 Spironolactone 50mg tablets : 29 Spironolactone 12.5mg tablets : 1 Spironolactone 100mg tablets : 7
Nicotine☰	1	Nicotine dependence	22	0.05	0.55	0.34	-1.49
NiQuitin 14mg patches : 1