Static outliers for Taverham Partnership

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 Taverham Partnership is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Alverine citrate/simeticone☰	3	Antispasmodic and other drugs altering gut motility	310	0.01	0.0	0.00	13.19
Alverine 60mg / Simeticone 300mg capsules : 3
Pericyazine☰	111	Antipsychotic drugs	762	0.15	0.0	0.02	7.36
Pericyazine 2.5mg tablets : 99 Pericyazine 10mg tablets : 12
Alogliptin/metformin☰	60	Other antidiabetic drugs	440	0.14	0.0	0.02	7.19
Alogliptin 12.5mg / Metformin 1g tablets : 60
Meptazinol hydrochloride☰	67	Opioid analgesics	1009	0.07	0.0	0.01	5.97
Meptazinol 200mg tablets : 67
Dapagliflozin/metformin☰	28	Other antidiabetic drugs	440	0.06	0.0	0.01	5.50
Dapagliflozin 5mg / Metformin 1g tablets : 23 Dapagliflozin 5mg / Metformin 850mg tablets : 5

Prescribing where Taverham Partnership is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Loperamide hydrochloride☰	87	Antimotility drugs	92	0.95	1.00	0.01	-4.43
Loperamide 2mg capsules : 83 Loperamide 1mg/5ml oral solution sugar free : 2 Loperamide 2mg tablets : 2
Permethrin☰	0	Parasiticidal preparations	3	0.00	0.84	0.25	-3.32
Combined ethinylestradiol 30mcg☰	112	Combined hormonal contraceptives	170	0.66	0.81	0.07	-2.03
Rigevidon tablets : 81 Microgynon 30 ED tablets : 2 Lucette 0.03mg/3mg tablets : 2 Marvelon tablets : 1 Ovranette 150microgram/30microgram tablets : 1 Levest 150/30 tablets (Morningside) : 1 Yasmin tablets : 3 Microgynon 30 tablets : 6 Gedarel 30microgram/150microgram tablets : 15
Isosorbide mononitrate☰	123	Nitrates	233	0.53	0.73	0.11	-1.88
Monomil XL 60mg tablets : 100 Isosorbide mononitrate 25mg modified-release tablets : 2 Isosorbide mononitrate 20mg tablets : 3 Isosorbide mononitrate 25mg modified-release capsules : 3 Carmil XL 60mg tablets (Milpharm) : 3 Isosorbide mononitrate 60mg modified-release tablets : 6 Xismox XL 60 tablets : 6
Dexamethasone☰	38	Otitis externa	70	0.54	0.78	0.13	-1.82
Otomize ear spray : 38