Static outliers for Park View 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 Park View Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Flupentixol hydrochloride☰	20	Antipsychotic drugs	119	0.17	0.00	0.01	19.42
Flupentixol 3mg tablets : 20
Phenobarbital☰	16	Control of epilepsy	328	0.05	0.01	0.01	6.85
Phenobarbital 60mg tablets : 11 Phenobarbital 30mg tablets : 5
Estradiol valerate☰	10	Oestrogens and Hormone Replacement Therapy	42	0.24	0.03	0.04	5.13
Estradiol valerate 1mg tablets : 5 Progynova 2mg tablets : 5
Atenolol with calcium channel blocker☰	4	Beta-adrenoceptor blocking drugs	807	0.00	0.00	0.00	5.12
Atenolol 50mg / Nifedipine 20mg modified-release capsules : 4
Paraffin soft yellow☰	4	Tear deficiency, eye lubricant/astringent	47	0.09	0.01	0.02	4.56
Simple eye ointment : 4

Prescribing where Park View Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gliclazide☰	75	Sulfonylureas	134	0.56	0.92	0.14	-2.69
Gliclazide 80mg tablets : 53 Gliclazide 60mg modified-release tablets : 4 Gliclazide 40mg tablets : 12 Gliclazide 30mg modified-release tablets : 6
Amlodipine☰	485	Calcium-channel blockers	1018	0.48	0.75	0.11	-2.45
Amlodipine 5mg tablets : 292 Amlodipine 10mg tablets : 193
Estradiol☰	5	Oestrogens and Hormone Replacement Therapy	42	0.12	0.46	0.14	-2.42
Estraderm MX 100 patches : 2 Estraderm MX 50 patches : 1 Evorel 75 patches : 1 Elleste Solo 1mg tablets : 1
Tamsulosin hydrochloride☰	107	Drugs for urinary retention	138	0.78	0.92	0.06	-2.35
Tamsulosin 400microgram modified-release capsules : 107
Methotrexate☰	12	Rheumatic disease suppressant drugs	50	0.24	0.58	0.15	-2.19
Methotrexate 2.5mg tablets : 12