Static outliers for Dr Ps Bath'S 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 Dr Ps Bath'S Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Zolpidem tartrate	203	Hypnotics	335	0.61	0.07	0.07	7.79
Zolpidem 10mg tablets : 180 Zolpidem 5mg tablets : 23
Naratriptan hydrochloride	34	Treatment of acute migraine	85	0.40	0.04	0.05	7.72
Naratriptan 2.5mg tablets : 34
Diethylamine salicylate	50	Rubefacients, topical NSAIDS, capsaicin and poultice	107	0.47	0.03	0.06	7.15
Algesal cream : 35 Diethylamine salicylate 10% cream : 15
Telmisartan with diuretic	12	Angiotensin-II receptor antagonists	456	0.03	0.00	0.00	6.28
Telmisartan 80mg / Hydrochlorothiazide 12.5mg tablets : 9 Telmisartan 40mg / Hydrochlorothiazide 12.5mg tablets : 3
Perindopril erbumine	657	Angiotensin-converting enzyme inhibitors	1073	0.61	0.09	0.10	5.31
Perindopril erbumine 2mg tablets : 41 Perindopril erbumine 4mg tablets : 445 Perindopril erbumine 8mg tablets : 171

Prescribing where Dr Ps Bath'S Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Zopiclone	55	Hypnotics	335	0.16	0.60	0.14	-3.13
Zopiclone 7.5mg tablets : 42 Zopiclone 3.75mg tablets : 13
Quinine sulfate	54	Antimalarials	105	0.51	0.89	0.14	-2.68
Quinine sulfate 200mg tablets : 40 Quinine sulfate 300mg tablets : 14
Ramipril	356	Angiotensin-converting enzyme inhibitors	1073	0.33	0.69	0.17	-2.15
Ramipril 1.25mg capsules : 54 Ramipril 2.5mg capsules : 83 Ramipril 5mg capsules : 123 Ramipril 10mg capsules : 85 Ramipril 5mg tablets : 4 Ramipril 2.5mg tablets : 7
Methylprednisolone acetate	0	Local corticosteroid injections	1	0.00	0.73	0.39	-1.87

Duloxetine hydrochloride	5	Other antidepressant drugs	300	0.02	0.15	0.07	-1.83
Duloxetine 30mg gastro-resistant capsules : 5