Static outliers for Octagon 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 Octagon Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Hydrocortisone butyrate	350	Topical corticosteroids	6394	0.05	0.00	0.01	9.60
Hydrocortisone butyrate 0.1% cream : 50 Locoid 0.1% cream : 56 Locoid 0.1% Lipocream : 235 Hydrocortisone butyrate 0.1% ointment : 1 Hydrocortisone butyrate 0.1% scalp lotion : 1 Locoid 0.1% ointment : 4 Locoid 0.1% scalp lotion : 3
Co-danthrusate (Dantron/docusate sodium)	6	Stimulant laxatives	2757	0.00	0.00	0.00	8.18
Co-danthrusate 50mg/60mg/5ml oral suspension sugar free : 6
Ethambutol hydrochloride	1	Antituberculosis drugs	1	1.00	0.06	0.18	5.14
Ethambutol 400mg tablets : 1
Ketoprofen	641	Rubefacients, topical NSAIDS, capsaicin and poultice	2413	0.27	0.02	0.06	4.04
Ketoprofen 2.5% gel : 610 Powergel 2.5% gel : 25 Oruvail 2.5% gel : 6
Nabilone	5	Drugs used in nausea and vertigo	3402	0.00	0.00	0.00	2.75
Nabilone 1mg capsules : 5

Prescribing where Octagon Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Rifampicin	0	Antituberculosis drugs	1	0.00	0.73	0.40	-1.81

Umeclidinium bromide/vilanterol	6	Compound bronchodilator preparations	467	0.01	0.50	0.31	-1.59
Anoro Ellipta 55microg/dose / 22microg/dose dry pdr inh : 6
Fluticasone furoate	141	Drugs used in nasal allergy	3035	0.05	0.22	0.13	-1.39
Fluticasone furoate 27.5micrograms/dose nasal spray : 99 Avamys 27.5micrograms/dose nasal spray : 42
Phytomenadione	0	Vitamin K	7	0.00	0.60	0.47	-1.29

Letrozole	276	Breast cancer	1493	0.18	0.44	0.22	-1.18
Letrozole 2.5mg tablets : 276