Static outliers for Burnham Surgery

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 Burnham Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Olmesartan medoxomil☰	643	Angiotensin-II receptor antagonists	1248	0.52	0.02	0.03	14.64
Olmesartan medoxomil 10mg tablets : 387 Olmesartan medoxomil 20mg tablets : 154 Olmesartan medoxomil 40mg tablets : 91 Olmetec 40mg tablets : 1 Olmetec 10mg tablets : 10
Erdosteine☰	40	Mucolytics	265	0.15	0.00	0.01	13.20
Erdosteine 300mg capsules : 40
Levocetirizine☰	80	Antihistamines	1077	0.07	0.00	0.01	8.25
Levocetirizine 5mg tablets : 78 Levocetirizine 500micrograms/ml oral solution sugar free : 1 Xyzal 5mg tablets : 1
Opium and morphine☰	1	Antimotility drugs	45	0.02	0.00	0.00	8.20
Kaolin and Morphine mixture : 1
Pericyazine☰	74	Antipsychotic drugs	463	0.16	0.00	0.02	8.09
Pericyazine 2.5mg tablets : 41 Pericyazine 10mg tablets : 33

Prescribing where Burnham Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Terbinafine hydrochloride☰	15	Other antifungals	18	0.83	0.99	0.03	-4.65
Terbinafine 250mg tablets : 15
Tamsulosin hydrochloride☰	586	Drugs for urinary retention	895	0.65	0.92	0.06	-4.35
Tamsulosin 400microgram modified-release capsules : 564 Tamsulosin 400microgram modified-release tablets : 22
Doxazosin mesilate☰	387	Alpha-adrenoceptor blocking drugs	424	0.91	0.99	0.02	-3.94
Doxazosin 1mg tablets : 47 Doxazosin 2mg tablets : 102 Doxazosin 4mg tablets : 232 Doxazosin 4mg modified-release tablets : 6
Naproxen☰	225	Non-steroidal anti-inflammatory drugs	735	0.31	0.69	0.10	-3.77
Naproxen 250mg tablets : 53 Naproxen 500mg tablets : 160 Naproxen 250mg gastro-resistant tablets : 2 Naproxen 500mg gastro-resistant tablets : 5 Naproxen 375mg gastro-resistant tablets : 5
Permethrin☰	0	Parasiticidal preparations	1	0.00	0.84	0.25	-3.32