Static outliers for Framlingham 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 Framlingham Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Etodolac☰	86	Non-steroidal anti-inflammatory drugs	713	0.12	0.01	0.02	7.49
Etodolac 600mg modified-release tablets : 86
Diltiazem hydrochloride☰	1105	Calcium-channel blockers	4648	0.24	0.05	0.03	6.99
Tildiem 60mg modified-release tablets : 43 Tildiem Retard 90mg tablets : 33 Zemtard 300 XL capsules : 73 Zemtard 120 XL capsules : 88 Zemtard 180 XL capsules : 256 Zemtard 240 XL capsules : 281 Viazem XL 120mg capsules : 124 Viazem XL 300mg capsules : 47 Viazem XL 360mg capsules : 34 Adizem-SR 120mg capsules : 2 Adizem-SR 180mg capsules : 1 Tildiem LA 200 capsules : 4 Adizem-XL 240mg capsules : 4 Adizem-SR 90mg capsules : 13 Viazem XL 240mg capsules : 27 Angitil SR 120 capsules : 3 Adizem-XL 300mg capsules : 16 Tildiem LA 300 capsules : 11 Viazem XL 180mg capsules : 25 Adizem-XL 180mg capsules : 10 Tildiem Retard 120mg tablets : 5 Adizem-XL 120mg capsules : 5
Gluten free/low protein pasta☰	10	Foods for special diets	79	0.13	0.00	0.02	6.93
Mevalia low protein fusilli : 1 Mevalia low protein pasta ditali : 1 Mevalia low protein penne : 3 Mevalia low protein spaghetti : 5
Lidocaine hydrochloride☰	14	Soothing haemorrhoidal preparations	14	1.00	0.06	0.15	6.25
Allantoin 10.25mg / Lidocaine 10.25mg suppositories : 2 Germoloids ointment : 7 Germoloids suppositories : 5
Chlohexidine gluconate (Emollient)☰	1	Emollients	90	0.01	0.00	0.00	6.05
Eczmol 1% cream : 1

Prescribing where Framlingham Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Zinc oxide☰	0	Soothing haemorrhoidal preparations	14	0.00	0.77	0.27	-2.89
Tiotropium bromide☰	65	Antimuscarinic bronchodilators	348	0.19	0.71	0.18	-2.87
Tiotropium bromide 18microgram inhalation pdr caps with dev : 1 Spiriva 18microgram inhalation pdr caps with HandiHaler : 1 Braltus 10microgram inhalation pdr caps with Zonda inhaler : 23 Spiriva 18microgram inhalation powder capsules : 4 Spiriva Respimat 2.5microg/dose inhalation soln refill cart : 6 Spiriva Respimat 2.5microg/dose inhalation soln : 20 Tiotropium bromide 18microgram inhalation powder capsules : 10
Apixaban☰	160	Oral anticoagulants	2613	0.06	0.40	0.14	-2.38
Apixaban 5mg tablets : 145 Apixaban 2.5mg tablets : 15
Doxycycline hyclate☰	102	Tetracyclines	317	0.32	0.63	0.14	-2.29
Doxycycline 100mg capsules : 102
Oral rehydration salts☰	0	Oral sodium and water	9	0.00	0.68	0.31	-2.20