Static outliers for Hoveton & Wroxham 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 Hoveton & Wroxham Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ferrous gluconate☰	407	Oral iron	724	0.56	0.03	0.05	9.78
Ferrous gluconate 300mg tablets : 407
Combined ethinylestradiol 20mcg☰	248	Combined hormonal contraceptives	375	0.66	0.12	0.07	8.23
Gedarel 20microgram/150microgram tablets : 221 Ethinylestradiol 20microgram / Drospirenone 3mg tablets : 2 Millinette 20microgram/75microgram tablets : 14 Eloine 0.02mg/3mg tablets : 11
Terazosin hydrochloride☰	66	Alpha-adrenoceptor blocking drugs	618	0.11	0.01	0.01	7.11
Terazosin 10mg tablets : 23 Terazosin 2mg tablets : 12 Terazosin 5mg tablets : 26 Hytrin 5mg tablets : 5
Pericyazine☰	151	Antipsychotic drugs	1113	0.14	0.00	0.02	6.85
Pericyazine 2.5mg tablets : 140 Pericyazine 10mg tablets : 11
Meptazinol hydrochloride☰	137	Opioid analgesics	1962	0.07	0.00	0.01	6.29
Meptazinol 200mg tablets : 137

Prescribing where Hoveton & Wroxham Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Combined ethinylestradiol 30mcg☰	118	Combined hormonal contraceptives	375	0.31	0.81	0.07	-6.72
Rigevidon tablets : 49 Gedarel 30microgram/150microgram tablets : 32 Lucette 0.03mg/3mg tablets : 2 Marvelon tablets : 1 Microgynon 30 tablets : 8 Millinette 30microgram/75microgram tablets : 11 Ovranette 150microgram/30microgram tablets : 15
Doxazosin mesilate☰	552	Alpha-adrenoceptor blocking drugs	618	0.89	0.99	0.02	-4.93
Doxazosin 1mg tablets : 43 Doxazosin 2mg tablets : 206 Doxazosin 4mg tablets : 211 Doxazosin 4mg modified-release tablets : 76 Doxazosin 8mg modified-release tablets : 16
Ispaghula husk☰	135	Bulk-forming laxatives	204	0.66	0.96	0.07	-4.06
Ispaghula husk 3.5g efferv gran sach gluten free sugar free : 49 Fybogel Orange 3.5g effervescent granules sachets SF : 68 Fybogel 3.5g effervescent granules sachets plain SF : 9 Fybogel Hi-Fibre Orange 3.5g effervescent granules sachets : 4 Fybogel Lemon 3.5g effervescent granules sachets SF : 5
Amlodipine☰	2127	Calcium-channel blockers	5521	0.39	0.75	0.11	-3.26
Amlodipine 5mg tablets : 1311 Amlodipine 10mg tablets : 805 Istin 10mg tablets : 6 Istin 5mg tablets : 5
Finasteride☰	385	Male sex hormones and antagonists	820	0.47	0.82	0.12	-3.03
Finasteride 5mg tablets : 385