Static outliers for Lister House 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 Lister House Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Chloral hydrate 106 Hypnotics 723 0.15 0.00 0.01 21.90
Hydroxyzine hydrochloride 390 Antihistamines 2293 0.17 0.02 0.03 5.76
Trandolapril 81 Angiotensin-converting enzyme inhibitors 4208 0.02 0.00 0.00 5.54
Magnesium trisilicate 2 Antacids and simeticone 3 0.67 0.03 0.14 4.67
Fluticasone propionate (Inhalation) 882 Corticosteroids (respiratory) 1613 0.55 0.18 0.08 4.54
Seretide 250 Accuhaler : 43
Seretide 50 Evohaler : 93
Seretide 125 Evohaler : 66
Seretide 250 Evohaler : 37
Flutiform 50micrograms/dose / 5micrograms/dose inhaler : 36
Sirdupla 25micrograms/dose / 125micrograms/dose inhaler : 77
Sirdupla 25micrograms/dose / 250micrograms/dose inhaler : 94
AirFluSal 25micrograms/dose / 125micrograms/dose inhaler : 112
AirFluSal 25micrograms/dose / 250micrograms/dose inhaler : 120
Sereflo 25micrograms/dose / 125micrograms/dose inhaler : 37
Fluticasone 50microg / Salmeterol 25microg/dose inh CFC free : 2
Fluticasone propionate 100micrograms/dose dry powder inhaler : 1
Fluticasone 50micrograms/dose inhaler CFC free : 1
Sereflo 25micrograms/dose / 250micrograms/dose inhaler : 13
Combisal 25micrograms/dose / 125micrograms/dose inhaler : 8
Fluticasone 125microg / Formoterol 5microg/dose inh CFC free : 17
Fluticasone 250microg / Formoterol 10microg/dose inh CFCfree : 12
Flutiform 250micrograms/dose / 10micrograms/dose inhaler : 7
Fluticasone 50microg / Formoterol 5microg/dose inh CFC free : 11
Seretide 500 Accuhaler : 25
Fluticasone propionate 250microg/Salmeterol 50microg/dose : 6
Fluticasone 250mcg/dose / Salmeterol 25mcg/dose inh CFC free : 6
Combisal 25micrograms/dose / 50micrograms/dose inhaler : 10
Flutiform 125micrograms/dose / 5micrograms/dose inhaler : 24
Fluticasone 125mcg/dose / Salmeterol 25mcg/dose inh CFC free : 5
Seretide 100 Accuhaler : 19

Prescribing where Lister House Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Combined ethinylestradiol 30mcg 118 Combined hormonal contraceptives 199 0.59 0.81 0.07 -2.93
Baclofen 52 Skeletal muscle relaxants 162 0.32 0.83 0.18 -2.74
Beclometasone dipropionate 418 Corticosteroids (respiratory) 1613 0.26 0.57 0.12 -2.61
Theophylline 26 Theophylline 80 0.32 0.83 0.25 -2.06
Amitriptyline hydrochloride 1110 Tricyclic and related antidepressant drugs 1624 0.68 0.84 0.08 -2.05