Static outliers for Thurmaston 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 Thurmaston Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Dicycloverine hydrochloride☰	28	Antispasmodic and other drugs altering gut motility	203	0.14	0.01	0.01	9.78
Dicycloverine 10mg tablets : 28
Levofloxacin☰	13	Antibacterials	61	0.21	0.01	0.02	9.30
Levofloxacin 5mg/ml eye drops : 7 Levofloxacin 5mg/ml eye dps 0.3ml ud preservative free : 6
Undecenoates☰	2	Antifungal preparations	37	0.05	0.00	0.01	7.76
Mycota cream : 2
Calcium polystyrene sulfonate☰	5	Oral potassium	10	0.50	0.01	0.07	7.10
Calcium Resonium powder : 5
Fulvestrant☰	2	Breast cancer	153	0.01	0.00	0.00	6.74
Fulvestrant 250mg/5ml inj pre-filled syringes : 2

Prescribing where Thurmaston Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Potassium chloride☰	5	Oral potassium	10	0.50	0.98	0.12	-4.04
Pot chloride 600mg / Pot bicarb 400mg (12mmol) efferv tab : 2 Sando-K effervescent tablets : 3
Amoxicillin☰	106	Broad-spectrum penicillins	191	0.55	0.81	0.09	-2.97
Amoxicillin 500mg capsules : 85 Amoxicillin 250mg capsules : 1 Amoxicillin 125mg/5ml oral suspension : 1 Amoxicillin 250mg/5ml oral suspension : 1 Amoxicillin 125mg/5ml oral suspension sugar free : 3 Amoxicillin 250mg/5ml oral suspension sugar free : 15
Omeprazole☰	371	Proton pump inhibitors	3540	0.10	0.50	0.16	-2.43
Omeprazole 20mg gastro-resistant capsules : 308 Losec 10mg gastro-resistant capsules : 2 Omeprazole 20mg dispersible gastro-resistant tablets : 1 Omeprazole 40mg gastro-resistant capsules : 28 Omeprazole 10mg gastro-resistant capsules : 27 Omeprazole 20mg gastro-resistant tablets : 5
Folic acid☰	242	Drugs used in megaloblastic anaemias	770	0.31	0.70	0.16	-2.42
Folic acid 5mg tablets : 238 Folic acid 5mg/5ml oral solution sugar free : 4
Salicylic acid☰	0	Preparations for warts and calluses	3	0.00	0.69	0.31	-2.20