Static outliers for New Southgate 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 New Southgate Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Titanium dioxide☰	1	Sunscreening preparations	8	0.12	0.00	0.01	23.01
Reflectant sunscreen beige (Dundee formula) cream : 1
Dexketoprofen☰	6	Non-steroidal anti-inflammatory drugs	1128	0.01	0.00	0.00	8.31
Dexketoprofen 25mg tablets : 6
Acetylcysteine☰	37	Mucolytics	103	0.36	0.02	0.08	4.43
Acetylcysteine 600mg capsules : 2 NACSYS 600mg effervescent tablets : 28 Acetylcysteine 600mg effervescent tablets sugar free : 7
Oxazepam☰	40	Anxiolytics	445	0.09	0.01	0.02	3.37
Oxazepam 10mg tablets : 33 Oxazepam 15mg tablets : 7
Deflazacort☰	5	Use of corticosteroids	428	0.01	0.00	0.00	3.16
Deflazacort 6mg tablets : 5

Prescribing where New Southgate Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbocisteine☰	64	Mucolytics	103	0.62	0.97	0.08	-4.35
Carbocisteine 375mg capsules : 62 Carbocisteine 750mg/5ml oral solution sugar free : 2
Azathioprine☰	31	Antiproliferative immunosuppressants	90	0.34	0.80	0.19	-2.47
Azathioprine 50mg tablets : 30 Azathioprine 25mg tablets : 1
Finasteride☰	164	Male sex hormones and antagonists	272	0.60	0.82	0.12	-1.88
Finasteride 5mg tablets : 164
Amlodipine☰	1840	Calcium-channel blockers	3320	0.55	0.75	0.11	-1.76
Amlodipine 5mg tablets : 968 Amlodipine 10mg tablets : 864 Amlodipine 5mg/5ml oral solution sugar free : 2 Istin 5mg tablets : 2 Amlodipine 2.5mg tablets : 4
Sodium chloride☰	0	Topical nasal decongestants	8	0.00	0.54	0.31	-1.72