Static outliers for Handsworth Medical Practice

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 Handsworth Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Clonazepam☰	2	Drugs used in status epilepticus	19	0.11	0.00	0.01	14.03
Clonazepam 1mg/1ml inj ampoules and diluent : 2
Levothyroxine sodium and liothyronine☰	10	Thyroid hormones	3004	0.00	0.00	0.00	7.87
Armour Thyroid 15mg (quarter grain) tablets : 5 Armour Thyroid 90mg (1 and a half grains) tablets : 5
Phenytoin sodium☰	211	Control of epilepsy	2882	0.07	0.02	0.02	3.32
Phenytoin sodium 100mg capsules : 85 Phenytoin sodium 25mg capsules : 35 Phenytoin sodium 50mg capsules : 58 Phenytoin sodium 100mg tablets : 8 Phenytoin sodium 300mg capsules : 25
Ofloxacin☰	4	Quinolones	9	0.44	0.09	0.11	3.26
Ofloxacin 200mg tablets : 4
Low protein grains/flours☰	2	Foods for special diets	128	0.02	0.00	0.00	3.24
Promin low protein all purpose baking mix : 2

Prescribing where Handsworth Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Insulin glargine☰	13	Intermediate and long-acting insulins	332	0.04	0.33	0.13	-2.20
Toujeo 300units/ml inj 1.5ml pre-filled SoloStar pens : 8 Lantus 100units/ml inj 3ml pre-filled SoloStar pens : 5
Indapamide☰	88	Thiazides and related diuretics	1153	0.08	0.42	0.16	-2.18
Indapamide 2.5mg tablets : 81 Natrilix SR 1.5mg tablets : 1 Indapamide 1.5mg modified-release tablets : 6
Allopurinol☰	425	Gout and cytotoxic induced hyperiuicaemia	546	0.78	0.89	0.05	-2.17
Allopurinol 100mg tablets : 241 Allopurinol 300mg tablets : 184
Ciprofloxacin☰	5	Quinolones	9	0.56	0.86	0.15	-2.04
Ciprofloxacin 250mg tablets : 2 Ciprofloxacin 500mg tablets : 2 Ciprofloxacin 250mg/5ml oral suspension : 1
Estradiol☰	18	Preparations for vaginal/vulval changes	121	0.15	0.55	0.21	-1.87
Vagifem 10microgram vaginal tablets : 1 Estradiol 10microgram pessaries : 17