Static outliers for Lakeside Healthcare Stamford

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 Lakeside Healthcare Stamford is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Apremilast☰	2	Rheumatic disease suppressant drugs	725	0.00	0.00	0.00	16.19
Otezla 30mg tablets : 2
Sodium phenylbutyrate☰	5	Drugs used in metabolic disorders	13	0.38	0.00	0.04	10.59
Sodium phenylbutyrate 500mg tablets : 5
Hydrocortisone butyrate☰	101	Topical corticosteroids	2475	0.04	0.00	0.01	7.03
Locoid 0.1% Lipocream : 81 Locoid 0.1% scalp lotion : 1 Hydrocortisone butyrate 0.1% cream : 9 Hydrocortisone butyrate 0.1% ointment : 4 Locoid 0.1% cream : 6
Aclidinium bromide☰	457	Antimuscarinic bronchodilators	1194	0.38	0.04	0.07	4.94
Eklira 322micrograms/dose Genuair : 440 Aclidinium bromide 375micrograms/dose dry powder inhaler : 17
Edoxaban☰	3509	Oral anticoagulants	6410	0.55	0.09	0.10	4.40
Edoxaban 30mg tablets : 1593 Edoxaban 60mg tablets : 1915 Edoxaban 15mg tablets : 1

Prescribing where Lakeside Healthcare Stamford is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Zinc sulfate monohydrate☰	0	Zinc	2	0.00	0.73	0.40	-1.84
Methylprednisolone acetate☰	1	Local corticosteroid injections	31	0.03	0.73	0.39	-1.79
Depo-Medrone 120mg/3ml suspension for injection vials : 1
Apixaban☰	973	Oral anticoagulants	6410	0.15	0.40	0.14	-1.75
Apixaban 2.5mg tablets : 410 Apixaban 5mg tablets : 563
Umeclidinium bromide/vilanterol☰	1	Compound bronchodilator preparations	63	0.02	0.50	0.31	-1.58
Anoro Ellipta 55microg/dose / 22microg/dose dry pdr inh : 1
Letrozole☰	96	Breast cancer	824	0.12	0.44	0.22	-1.50
Letrozole 2.5mg tablets : 92 Femara 2.5mg tablets : 4