Static outliers for Haverhill Family 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 Haverhill Family Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Rotavirus☰	1	Vaccines and antisera	49	0.02	0.00	0.00	35.28
Rotarix vaccine live oral suspension 1.5ml tube : 1
Meptazinol hydrochloride☰	340	Opioid analgesics	3294	0.10	0.00	0.01	9.40
Meptazinol 200mg tablets : 335 Meptid 200mg tablets : 5
Tetracycline☰	41	Tetracyclines	586	0.07	0.01	0.01	5.18
Tetracycline 250mg tablets : 41
Hydrogen peroxide☰	3	Mouth-washes, gargles and dentifrices	13	0.23	0.01	0.05	4.17
Peroxyl 1.5% mouthwash : 3
Glipizide☰	42	Sulfonylureas	662	0.06	0.00	0.01	4.16
Glipizide 5mg tablets : 42

Prescribing where Haverhill Family Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Chlorhexidine gluconate☰	9	Mouth-washes, gargles and dentifrices	13	0.69	0.97	0.11	-2.67
Chlorhexidine glucon 0.06%/Sod fluoride 0.05% mouthwash SF : 1 Corsodyl Mint 0.2% mouthwash : 3 Chlorhexidine gluconate 0.2% mouthwash : 5
Loperamide hydrochloride☰	169	Antimotility drugs	174	0.97	1.00	0.01	-2.24
Loperamide 2mg capsules : 126 Loperamide 2mg tablets : 29 Loperamide 1mg/5ml oral solution sugar free : 8 Loperamide 2mg orodispersible tablets sugar free : 6
Clopidogrel☰	951	Antiplatelet drugs	4373	0.22	0.32	0.06	-1.65
Clopidogrel 75mg tablets : 951
Theophylline☰	36	Theophylline	83	0.43	0.83	0.25	-1.62
Uniphyllin Continus 200mg tablets : 30 Uniphyllin Continus 400mg tablets : 6
Ganciclovir☰	0	Antivirals	1	0.00	0.68	0.42	-1.60