Static outliers for Coastal Villages 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 Coastal Villages Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Pericyazine☰	189	Antipsychotic drugs	1388	0.14	0.00	0.02	6.87
Pericyazine 2.5mg tablets : 167 Pericyazine 10mg tablets : 22
Vildagliptin☰	71	Other antidiabetic drugs	1555	0.05	0.00	0.01	4.94
Vildagliptin 50mg tablets : 71
Aripiprazole☰	2	Antipsychotic depot injections	2	1.00	0.08	0.21	4.47
Aripiprazole 400mg inj vials : 1 Aripiprazole 400mg inj pre-filled syringes : 1
Diamorphine hydrochloride (Systemic)☰	33	Opioid analgesics	3447	0.01	0.00	0.00	3.92
Diamorphine 10mg powder for solution for injection ampoules : 17 Diamorphine 5mg powder for solution for injection ampoules : 16
Empagliflozin/linagliptin☰	7	Other antidiabetic drugs	1555	0.00	0.00	0.00	3.55
Empagliflozin 10mg / Linagliptin 5mg tablets : 7

Prescribing where Coastal Villages Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Glycopyrronium bromide☰	0	Antimuscarinic drugs	5	0.00	0.82	0.36	-2.30
Apixaban☰	322	Oral anticoagulants	4157	0.08	0.40	0.14	-2.27
Apixaban 2.5mg tablets : 115 Apixaban 5mg tablets : 207
Diazepam☰	278	Anxiolytics	560	0.50	0.75	0.14	-1.90
Diazepam 2mg tablets : 177 Diazepam 5mg tablets : 85 Diazepam 10mg tablets : 6 Diazepam 2mg/5ml oral solution sugar free : 10
Tadalafil☰	29	Drugs for erectile dysfunction	791	0.04	0.19	0.09	-1.79
Cialis 20mg tablets : 2 Tadalafil 2.5mg tablets : 4 Tadalafil 20mg tablets : 17 Tadalafil 5mg tablets : 6
Indapamide☰	395	Thiazides and related diuretics	2312	0.17	0.42	0.16	-1.58
Indapamide 2.5mg tablets : 354 Indapamide 1.5mg modified-release tablets : 41