Static outliers for Holt 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 Holt Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Triamcinolone hexacetonide	84	Local corticosteroid injections	86	0.98	0.00	0.03	28.09
Triamcinolone hexacetonide 20mg/1ml inj ampoules : 84
Meptazinol hydrochloride	250	Opioid analgesics	2875	0.09	0.00	0.01	7.89
Meptazinol 200mg tablets : 249 Meptid 200mg tablets : 1
Pericyazine	198	Antipsychotic drugs	1414	0.14	0.00	0.02	7.07
Pericyazine 2.5mg tablets : 194 Pericyazine 10mg tablets : 4
Oils for the ear	1	Removal of ear wax and other substances	2	0.50	0.01	0.10	4.72
Generic Earex ear drops : 1
Hydrocortisone acetate	41	Otitis externa	178	0.23	0.03	0.04	4.61
Gentamicin 0.3% / Hydrocortisone acetate 1% ear drops : 41

Prescribing where Holt Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Amlodipine	2622	Calcium-channel blockers	7889	0.33	0.75	0.11	-3.72
Amlodipine 5mg tablets : 1641 Amlodipine 10mg tablets : 930 Amlodipine 2.5mg tablets : 32 Istin 5mg tablets : 19
Fusidic acid	28	Antibacterial preparations also used systemically	114	0.25	0.72	0.15	-3.11
Fucidin 20mg/g cream : 4 Fusidic acid 2% cream : 24
Losartan potassium	407	Angiotensin-II receptor antagonists	5406	0.08	0.50	0.19	-2.28
Losartan 25mg tablets : 83 Losartan 50mg tablets : 140 Losartan 100mg tablets : 169 Losartan 12.5mg tablets : 9 Cozaar 25mg tablets : 6
Ramipril	2133	Angiotensin-converting enzyme inhibitors	6299	0.34	0.69	0.17	-2.11
Ramipril 1.25mg capsules : 367 Ramipril 2.5mg capsules : 777 Ramipril 5mg capsules : 565 Ramipril 10mg capsules : 409 Ramipril 5mg tablets : 10 Ramipril 10mg tablets : 5
Apixaban	476	Oral anticoagulants	4118	0.12	0.40	0.14	-2.00
Apixaban 2.5mg tablets : 177 Apixaban 5mg tablets : 288 Eliquis 5mg tablets : 11