Static outliers for Village 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 Village Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Linagliptin/metformin☰	127	Other antidiabetic drugs	1260	0.10	0.00	0.01	7.42
Linagliptin 2.5mg / Metformin 850mg tablets : 39 Linagliptin 2.5mg / Metformin 1g tablets : 88
Nefopam hydrochloride☰	473	Non-opioid analgesics and compound preparations	3812	0.12	0.01	0.02	6.78
Nefopam 30mg tablets : 473
Glucose☰	14	Foods for special diets	14	1.00	0.08	0.14	6.54
Lift Glucose tablets blueberry : 4 Lift Glucose Shot liquid lemon & lime : 10
Paraldehyde☰	6	Drugs used in status epilepticus	13	0.46	0.01	0.08	5.74
Paraldehyde 50% in Olive oil rectal solution : 6
Liraglutide☰	205	Other antidiabetic drugs	1260	0.16	0.03	0.03	4.66
Liraglutide 6mg/1ml inj 3ml pre-filled disposable devices : 95 Victoza 6mg/ml solution for injection 3ml pre-filled pens : 110

Prescribing where Village Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Midazolam hydrochloride☰	0	Drugs used in status epilepticus	13	0.00	0.79	0.30	-2.62
Other food for special diet preparations☰	0	Foods for special diets	14	0.00	0.65	0.25	-2.61
Senna☰	183	Stimulant laxatives	874	0.21	0.55	0.14	-2.47
Senna 7.5mg tablets : 173 Senna 15mg tablets : 1 Senna 7.5mg/5ml oral solution sugar free : 9
Omeprazole☰	647	Proton pump inhibitors	6389	0.10	0.50	0.16	-2.45
Omeprazole 20mg gastro-resistant capsules : 519 Omeprazole 40mg gastro-resistant capsules : 90 Omeprazole 10mg gastro-resistant capsules : 30 Losec MUPS 10mg gastro-resistant tablets : 2 Omeprazole 10mg dispersible gastro-resistant tablets : 1 Omeprazole 20mg dispersible gastro-resistant tablets : 5
Glycopyrronium bromide☰	0	Antimuscarinic drugs	5	0.00	0.82	0.36	-2.30