Static outliers for Lowmoor Road Surgery

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 Lowmoor Road Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Benperidol	11	Antipsychotic drugs	449	0.02	0.00	0.00	10.68
Benperidol 250microgram tablets : 11
Lidocaine hydrochloride	6	Drugs for oral ulceration and inflammation	25	0.24	0.01	0.04	5.67
Iglu Rapid Relief oromucosal gel : 6
Chlorpromazine hydrochloride	80	Antipsychotic drugs	449	0.18	0.02	0.03	5.37
Chlorpromazine 25mg tablets : 42 Chlorpromazine 100mg tablets : 21 Chlorpromazine 25mg/5ml oral solution : 6 Chlorpromazine 50mg tablets : 6 Chlorpromazine 100mg/5ml oral solution : 5
Propantheline bromide	54	Antispasmodic and other drugs altering gut motility	419	0.13	0.01	0.02	5.01
Propantheline bromide 15mg tablets : 54
Clobetasol propionate	139	Topical corticosteroids	593	0.23	0.08	0.03	4.81
Clobetasol 0.05% cream : 61 Dermovate 0.05% scalp application : 1 ClobaDerm 0.05% ointment (Accord Healthcare) : 1 Dermovate 0.05% ointment : 18 Clobetasol 0.05% ointment : 27 Dermovate 0.05% cream : 26 Etrivex 500micrograms/g shampoo : 5

Prescribing where Lowmoor Road Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Midazolam hydrochloride	0	Drugs used in status epilepticus	1	0.00	0.79	0.30	-2.62

Sumatriptan succinate	88	Treatment of acute migraine	223	0.39	0.67	0.12	-2.23
Sumatriptan 50mg tablets : 44 Sumatriptan 100mg tablets : 26 Sumatriptan 10mg/0.1ml nasal spray unit dose : 7 Sumatriptan 6mg/0.5ml inj pre-filled disposable devices : 6 Sumatriptan 6mg/0.5ml inj pre-filled syringes with device : 5
Hydrocortisone	4	Copound haemorrhoidal preparations with corticosteroid	43	0.09	0.58	0.24	-2.03
Anusol HC ointment : 2 Cinchocaine 0.5% / Hydrocortisone 0.5% ointment : 1 Proctosedyl ointment : 1
Prochlorperazine maleate	34	Drugs used in nausea and vertigo	422	0.08	0.25	0.09	-1.92
Prochlorperazine 5mg tablets : 34
Methylprednisolone acetate	0	Local corticosteroid injections	11	0.00	0.73	0.39	-1.87