Static outliers for Bottisham 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 Bottisham Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Camellia sinensis extract☰	2	Preparations for warts and calluses	7	0.29	0.00	0.01	36.92
Catephen 10% ointment : 2
Meptazinol hydrochloride☰	99	Opioid analgesics	1144	0.09	0.00	0.01	7.85
Meptazinol 200mg tablets : 69 Meptid 200mg tablets : 30
Nedocromil sodium☰	1	Cromoglycate and related therapy	1	1.00	0.03	0.15	6.27
Nedocromil 2mg/dose inhaler CFC free : 1
Ephedrine hydrochloride☰	3	Systemic nasal decongestants	3	1.00	0.04	0.18	5.25
Haymine tablets : 3
Chlortalidone☰	11	Thiazides and related diuretics	585	0.02	0.00	0.00	4.85
Chlortalidone 50mg tablets : 11

Prescribing where Bottisham Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sodium cromoglicate☰	0	Cromoglycate and related therapy	1	0.00	0.97	0.15	-6.27
Pseudoephedrine hydrochloride☰	0	Systemic nasal decongestants	3	0.00	0.96	0.18	-5.25
Amoxicillin☰	175	Broad-spectrum penicillins	300	0.58	0.81	0.09	-2.65
Amoxicillin 500mg capsules : 113 Amoxicillin 250mg/5ml oral suspension sugar free : 43 Amoxicillin 125mg/5ml oral suspension : 1 Amoxicillin 125mg/5ml oral suspension sugar free : 4 Amoxicillin 250mg/5ml oral suspension : 3 Amoxicillin 250mg capsules : 11
Medroxyprogesterone acetate☰	15	Parenteral progestogen-only contraceptives	32	0.47	0.88	0.16	-2.54
Sayana Press 104mg/0.65ml inj pre-filled disposable devices : 2 Depo-Provera 150mg/1ml inj pre-filled syringes : 8 Medroxyprogesterone 150mg/1ml inj pre-filled syringes : 5
Pizotifen malate☰	1	Prophylaxis of migraine	46	0.02	0.65	0.26	-2.41
Pizotifen 500microgram tablets : 1