Static outliers for Welbeck Road Health 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 Welbeck Road Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Hepatitis A/hepatitis B	3	Vaccines and antisera	5	0.60	0.01	0.05	11.61
Twinrix Adult vacc inj 1ml pre-filled syringes : 3
Dibrompropamidine isetionate	1	Antibacterials	64	0.02	0.00	0.00	10.57
Dibrompropamidine 0.15% eye ointment : 1
Lixisenatide	49	Other antidiabetic drugs	1171	0.04	0.00	0.01	6.47
Lixisenatide 20micrograms/0.2ml inj 3ml pf dispos dev : 46 Lixisenatide 10microg/0.2ml and 20microg/0.2ml inj : 3
Other topical nasal decongestant preparations	1	Topical nasal decongestants	32	0.03	0.00	0.01	5.51
Levomenthol 0.3% ointment : 1
Chlohexidine gluconate (Emollient)	3	Emollients	296	0.01	0.00	0.00	5.51
Eczmol 1% cream : 3

Prescribing where Welbeck Road Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Cefalexin	46	Cephalosporins	72	0.64	0.96	0.10	-3.14
Cefalexin 250mg capsules : 2 Cefalexin 250mg/5ml oral suspension : 2 Cefalexin 250mg tablets : 7 Cefalexin 500mg capsules : 25 Cefalexin 125mg/5ml oral suspension : 10
Benzoyl peroxide and clindamycin phosphate	11	Topical preparations for acne	174	0.06	0.38	0.14	-2.27
Benzoyl peroxide 3% / Clindamycin 1% gel : 2 Duac Once Daily gel (3% and 1%) : 1 Duac Once Daily gel (5% and 1%) : 3 Benzoyl peroxide 5% / Clindamycin 1% gel : 5
Indapamide	146	Thiazides and related diuretics	1744	0.08	0.42	0.16	-2.13
Indapamide 2.5mg tablets : 106 Indapamide 1.5mg modified-release tablets : 40
Co-amilofruse (Amiloride hydrochloride/frusemide)	0	Potassium sparing diuretics and compounds	2	0.00	0.68	0.33	-2.07

Apixaban	246	Oral anticoagulants	2149	0.11	0.40	0.14	-2.01
Apixaban 2.5mg tablets : 69 Apixaban 5mg tablets : 177