Static outliers for Eastwood Primary Care 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 Eastwood Primary Care Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gluten free/low protein drink☰	2	Foods for special diets	305	0.01	0.00	0.00	4.50
Mevalia Lattis low protein drink : 2
Flumetasone pivalate☰	27	Otitis externa	304	0.09	0.01	0.02	4.04
Flumetasone 0.02% / Clioquinol 1% ear drops : 27
Beclometasone dipropionate☰	967	Drugs used in nasal allergy	1365	0.71	0.24	0.12	3.78
Beclometasone 50micrograms/dose nasal spray : 139 Beconase Aqueous 50micrograms/dose nasal spray : 828
Low protein pasta☰	23	Foods for special diets	305	0.08	0.00	0.02	3.68
Loprofin low protein pasta macaroni elbows : 4 Loprofin low protein pasta long cut spaghetti : 4 Loprofin low protein pasta fusilli : 4 Loprofin low protein pasta tagliatelle : 4 Loprofin low protein pasta animal shapes : 4 Loprofin low protein pasta lasagne : 3
Triptorelin☰	46	Prostate cancer and gonadorelin analogues	70	0.66	0.09	0.16	3.66
Decapeptyl SR 11.25mg inj vials : 46

Prescribing where Eastwood Primary Care Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Alfentanil hydrochloride☰	0	Opioid analgesics	4	0.00	0.82	0.37	-2.21
Other multivitamin preparations☰	155	Multivitamin preparations	434	0.36	0.81	0.21	-2.18
Multivitamin tablets : 40 Forceval capsules : 62 Healthy Start Children's Vitamin drops : 2 Valupak Multivitamin One A Day tablets : 9 Abidec Multivitamin drops : 18 Renavit tablets : 18 Paravit-cf capsules : 6
Quinine sulfate☰	275	Antimalarials	456	0.60	0.89	0.14	-2.05
Quinine sulfate 200mg tablets : 100 Quinine sulfate 300mg tablets : 175
Fusidic acid☰	35	Antibacterial preparations also used systemically	79	0.44	0.72	0.15	-1.83
Fusidic acid 2% cream : 33 Fucidin 20mg/g cream : 2
Ivermectin☰	10	Topical preparation for rosacea	20	0.50	0.88	0.24	-1.59
Soolantra 10mg/g cream : 2 Ivermectin 10mg/g cream : 8