Static outliers for Selston 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 Selston Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Propiverine hydrochloride☰	17	Drugs for urinary frequency enuresis and incontinence	215	0.08	0.00	0.01	8.34
Detrunorm XL 30mg capsules : 12 Detrunorm 15mg tablets : 5
Hydrocortisone butyrate☰	13	Topical corticosteroids	380	0.03	0.00	0.01	5.82
Hydrocortisone butyrate 0.1% cream : 13
Trifluoperazine☰	12	Antipsychotic drugs	271	0.04	0.00	0.01	5.31
Trifluoperazine 5mg tablets : 6 Trifluoperazine 5mg/5ml oral solution sugar free : 6
Linagliptin☰	316	Other antidiabetic drugs	479	0.66	0.16	0.11	4.67
Linagliptin 5mg tablets : 316
Other oral iron preparations☰	11	Oral iron	382	0.03	0.00	0.01	4.24
Spatone Original 20ml sachets : 11

Prescribing where Selston Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Alfentanil hydrochloride☰	0	Opioid analgesics	2	0.00	0.82	0.37	-2.21
Codeine phosphate☰	0	Cough suppressants	1	0.00	0.76	0.35	-2.18
Clobetasone butyrate☰	12	Topical corticosteroids	380	0.03	0.13	0.05	-2.00
Clobetasone 0.05% ointment : 2 Eumovate 0.05% cream : 2 Clobetasone 0.05% cream : 8
Atorvastatin☰	2163	Lipid-regulating drugs	4310	0.50	0.66	0.08	-1.95
Atorvastatin 10mg tablets : 380 Atorvastatin 20mg tablets : 1069 Atorvastatin 40mg tablets : 456 Atorvastatin 80mg tablets : 257 Atorvastatin 10mg chewable tablets sugar free : 1
Mirabegron☰	11	Drugs for urinary frequency enuresis and incontinence	215	0.05	0.22	0.09	-1.88
Mirabegron 50mg modified-release tablets : 11