Static outliers for Long Sutton Medical Ctr.

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 Long Sutton Medical Ctr. is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Flupentixol hydrochloride☰	766	Other antidepressant drugs	5807	0.13	0.01	0.01	10.20
Flupentixol 500microgram tablets : 589 Flupentixol 1mg tablets : 176 Fluanxol 500microgram tablets : 1
Alimemazine tartrate☰	175	Antihistamines	3972	0.04	0.00	0.00	9.88
Alimemazine 10mg tablets : 159 Alimemazine 7.5mg/5ml oral solution : 16
Budesonide☰	254	Drugs used in nasal allergy	1446	0.18	0.01	0.02	8.70
Budesonide 64micrograms/dose nasal spray : 253 Rhinocort Aqua 64 nasal spray : 1
Almotriptan☰	143	Treatment of acute migraine	747	0.19	0.01	0.02	7.62
Almotriptan 12.5mg tablets : 143
Oxazepam☰	265	Anxiolytics	1434	0.18	0.01	0.02	7.35
Oxazepam 10mg tablets : 220 Oxazepam 15mg tablets : 45

Prescribing where Long Sutton Medical Ctr. is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Vitamin B compound☰	441	Vitamin B compound	447	0.99	1.00	0.00	-4.31
Vitamin B compound tablets : 44 Vitamin B compound strong tablets : 397
Gliclazide☰	1118	Sulfonylureas	1977	0.57	0.92	0.14	-2.65
Gliclazide 80mg tablets : 726 Gliclazide 30mg modified-release tablets : 44 Gliclazide 40mg tablets : 343 Gliclazide 60mg modified-release tablets : 5
Mirtazapine☰	1768	Other antidepressant drugs	5807	0.30	0.57	0.11	-2.48
Mirtazapine 30mg tablets : 482 Mirtazapine 15mg tablets : 835 Mirtazapine 45mg tablets : 393 Mirtazapine 45mg orodispersible tablets : 12 Mirtazapine 15mg orodispersible tablets : 26 Mirtazapine 30mg orodispersible tablets : 20
Amlodipine☰	5269	Calcium-channel blockers	11049	0.48	0.75	0.11	-2.45
Amlodipine 5mg tablets : 3316 Amlodipine 10mg tablets : 1876 Amlodipine 2.5mg tablets : 56 Istin 10mg tablets : 9 Istin 5mg tablets : 12
Vitamin A☰	0	Vitamin A	4	0.00	0.84	0.35	-2.42