Static outliers for Manor Farm 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 Manor Farm Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Ketoprofen	653	Rubefacients, topical NSAIDS, capsaicin and poultice	905	0.72	0.02	0.06	11.60
Ketoprofen 2.5% gel : 638 Powergel 2.5% gel : 15
Olmesartan medoxomil	662	Angiotensin-II receptor antagonists	2061	0.32	0.02	0.03	8.96
Olmesartan medoxomil 10mg tablets : 199 Olmesartan medoxomil 20mg tablets : 251 Olmesartan medoxomil 40mg tablets : 206 Olmetec 40mg tablets : 6
Darifenacin hydrobromide	197	Drugs for urinary frequency enuresis and incontinence	785	0.25	0.01	0.04	6.51
Darifenacin 7.5mg modified-release tablets : 102 Darifenacin 15mg modified-release tablets : 87 Emselex 15mg modified-release tablets : 8
Tacalcitol	10	Preparations for psoriasis	99	0.10	0.00	0.02	5.79
Curatoderm 4micrograms/g ointment : 10
Meptazinol hydrochloride	156	Opioid analgesics	2576	0.06	0.00	0.01	5.42
Meptazinol 200mg tablets : 156

Prescribing where Manor Farm Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Somatropin	0	Hypothalamic & anterior pituitary hormone & antioestrogens	1	0.00	0.90	0.27	-3.31

Naproxen	333	Non-steroidal anti-inflammatory drugs	820	0.41	0.69	0.10	-2.78
Naproxen 250mg tablets : 181 Naproxen 500mg tablets : 148 Naproxen 500mg gastro-resistant tablets : 1 Naproxen 250mg gastro-resistant tablets : 3
Dexamethasone	29	Otitis externa	66	0.44	0.78	0.13	-2.60
Otomize ear spray : 29
Amlodipine	1945	Calcium-channel blockers	3953	0.49	0.75	0.11	-2.31
Amlodipine 5mg tablets : 1315 Amlodipine 10mg tablets : 618 Amlodipine 2.5mg tablets : 2 Istin 5mg tablets : 10
Mercaptopurine	0	Antimetabolites	27	0.00	0.80	0.35	-2.31