Static outliers for Outwood Park Medical Centre

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 Outwood Park Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Co-fluampicil(Flucloxacillin/ampicillin)	19	Broad-spectrum penicillins	820	0.02	0.00	0.00	15.11
Co-fluampicil 250mg/250mg capsules : 19
Ospemifene	3	Preparations for vaginal/vulval changes	161	0.02	0.00	0.00	8.98
Ospemifene 60mg tablets : 3
Other otitis external preparations	1	Otitis externa	187	0.01	0.00	0.00	6.81
Otocomb Otic ear ointment : 1
Acetylcysteine	115	Mucolytics	223	0.52	0.02	0.08	6.48
Acetylcysteine 600mg effervescent tablets sugar free : 33 NACSYS 600mg effervescent tablets : 82
Hepatitis A/typhoid vaccine	2	Vaccines and antisera	11	0.18	0.01	0.04	4.28
ViATIM vacc inj 1ml pre-filled syringes : 2

Prescribing where Outwood Park Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Carbocisteine	104	Mucolytics	223	0.47	0.97	0.08	-6.28
Carbocisteine 375mg capsules : 93 Carbocisteine 750mg/5ml oral solution sugar free : 4 Carbocisteine 250mg/5ml oral solution : 7
Fusidic acid	14	Antibacterial preparations also used systemically	41	0.34	0.72	0.15	-2.49
Fusidic acid 2% cream : 14
Amlodipine	1933	Calcium-channel blockers	4015	0.48	0.75	0.11	-2.41
Amlodipine 5mg tablets : 1064 Amlodipine 10mg tablets : 861 Amlodipine 2.5mg tablets : 1 Amlodipine 5mg/5ml oral solution sugar free : 7
Latanoprost	165	Treatment of glaucoma	1164	0.14	0.31	0.08	-1.98
Latanoprost 50micrograms/ml eye drops : 122 Latanoprost 50micrograms/ml eye dps 0.2ml ud preserv free : 33 Xalatan 50micrograms/ml eye drops : 1 Monopost 50micrograms/ml eye drops 0.2ml unit dose : 9
Methylprednisolone acetate	0	Local corticosteroid injections	312	0.00	0.73	0.39	-1.87