Static outliers for Devonshire Green Medical 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 Devonshire Green Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Mexiletine hydrochloride☰	7	Drugs for arrhythmias	12	0.58	0.00	0.01	46.59
Mexiletine 50mg capsules : 7
Nefopam hydrochloride☰	315	Non-opioid analgesics and compound preparations	1561	0.20	0.01	0.02	11.33
Nefopam 30mg tablets : 315
Hydrocortisone sodium succinate☰	5	Use of corticosteroids	302	0.02	0.00	0.00	5.42
Hydrocortisone sodium succinate 100mg inj vials : 1 Solu-Cortef 100mg inj vials : 4
Dronabinol/cannabidiol☰	4	Skeletal muscle relaxants	96	0.04	0.00	0.01	4.65
Sativex oromucosal spray : 4
Fluocinonide☰	6	Topical corticosteroids	478	0.01	0.00	0.00	4.50
Metosyn FAPG 0.05% cream : 2 Metosyn 0.05% ointment : 4

Prescribing where Devonshire Green Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Somatropin☰	0	Hypothalamic & anterior pituitary hormone & antioestrogens	1	0.00	0.90	0.27	-3.31
Aciclovir☰	41	Herpes simplex and varicella-zoster	55	0.75	0.95	0.07	-3.03
Aciclovir 400mg tablets : 34 Aciclovir 200mg tablets : 2 Aciclovir 200mg dispersible tablets : 1 Aciclovir 800mg tablets : 4
Insulin aspart☰	42	Short-acting insulins	84	0.50	0.79	0.12	-2.49
Fiasp Penfill 100units/ml inj 3ml cartridges : 2 NovoRapid FlexTouch 100units/ml inj 3ml pre-filled pens : 1 NovoRapid FlexPen 100units/ml inj 3ml pre-filled pens : 22 NovoRapid Penfill 100units/ml inj 3ml cartridges : 12 NovoRapid 100units/ml solution for injection 10ml vials : 5
Prednisolone☰	224	Use of corticosteroids	302	0.74	0.88	0.06	-2.19
Prednisolone 5mg tablets : 180 Prednisolone 5mg gastro-resistant tablets : 1 Prednisolone 2.5mg tablets : 3 Prednisolone 1mg gastro-resistant tablets : 3 Prednisolone 2.5mg gastro-resistant tablets : 12 Prednisolone 1mg tablets : 25
Prucalopride☰	0	Other drugs used in constipation	1	0.00	0.71	0.33	-2.18