Static outliers for Rawmarsh Health 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 Rawmarsh Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Stiripentol☰	10	Control of epilepsy	768	0.01	0.00	0.00	21.37
Stiripentol 250mg oral powder sachets : 5 Stiripentol 500mg oral powder sachets : 5
Pantoprazole☰	447	Proton pump inhibitors	2168	0.21	0.02	0.02	8.36
Pantoprazole 40mg gastro-resistant tablets : 376 Pantoprazole 20mg gastro-resistant tablets : 71
Acetylcysteine☰	12	Tear deficiency, eye lubricant/astringent	90	0.13	0.01	0.02	6.73
Acetylcysteine 5% eye drops : 12
Phosphates (Rectal)☰	13	Osmotic laxatives	196	0.07	0.01	0.01	6.48
Phosphates enema (Formula B) 128ml standard tube : 13
Zonisamide☰	44	Control of epilepsy	768	0.06	0.01	0.01	6.28
Zonisamide 100mg capsules : 22 Zonisamide 50mg capsules : 22

Prescribing where Rawmarsh Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Calcium carbonate☰	3	Calcium supplements	8	0.38	0.95	0.13	-4.32
Adcal 1500mg chewable tablets : 3
Alendronic acid☰	104	Bisphosphonates and other drugs	188	0.55	0.87	0.09	-3.45
Alendronic acid 70mg tablets : 98 Alendronic acid 70mg effervescent tablets sugar free : 6
Finasteride☰	41	Male sex hormones and antagonists	80	0.51	0.82	0.12	-2.66
Finasteride 5mg tablets : 41
Midazolam hydrochloride☰	0	Drugs used in status epilepticus	1	0.00	0.79	0.30	-2.62
Glycopyrronium bromide☰	0	Antimuscarinic drugs	1	0.00	0.82	0.36	-2.30