Static outliers for Queens Park Health 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 Queens Park Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Calcitriol☰	46	Vitamin D	1093	0.04	0.00	0.00	10.13
Calcitriol 250nanogram capsules : 46
Hydrocortisone☰	14	Otitis externa	76	0.18	0.01	0.02	7.77
Otosporin ear drops : 14
Acetylcysteine☰	89	Mucolytics	162	0.55	0.02	0.08	6.93
NACSYS 600mg effervescent tablets : 86 OroNAC 600 effervescent tablets : 3
Eflornithine monohydrate chloride☰	4	Shampoos and some other scalp preparations	17	0.24	0.02	0.03	6.16
Eflornithine 11.5% cream : 4
Dimenhydrinate/cinnarizine☰	11	Drugs used in nausea and vertigo	477	0.02	0.00	0.00	5.55
Cinnarizine 20mg / Dimenhydrinate 40mg tablets : 11

Prescribing where Queens Park Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbocisteine☰	69	Mucolytics	162	0.43	0.97	0.08	-6.78
Carbocisteine 375mg capsules : 48 Carbocisteine 250mg/5ml oral solution sugar free : 1 Carbocisteine 250mg/5ml oral solution : 20
Quinine sulfate☰	37	Antimalarials	69	0.54	0.89	0.14	-2.52
Quinine sulfate 200mg tablets : 17 Quinine sulfate 300mg tablets : 20
Benzydamine hydrochloride☰	4	Drugs for oral ulceration and inflammation	10	0.40	0.83	0.18	-2.30
Benzydamine 0.15% oromucosal spray sugar free : 4
Baclofen☰	80	Skeletal muscle relaxants	193	0.41	0.83	0.18	-2.24
Baclofen 10mg tablets : 75 Baclofen 5mg/5ml oral solution sugar free : 5
Fluconazole☰	24	Triazole antifungals	42	0.57	0.85	0.15	-1.89
Fluconazole 50mg capsules : 14 Fluconazole 150mg capsules : 10