Static outliers for Kings Road 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 Kings Road Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Erdosteine☰	12	Mucolytics	53	0.23	0.00	0.01	19.90
Erdotin 300mg capsules : 2 Erdosteine 300mg capsules : 10
Emulsifying wax☰	60	Emollients	232	0.26	0.01	0.03	8.51
Emulsifying ointment : 60
Olmesartan medoxomil/hydrochlorothiazide☰	23	Angiotensin-II receptor antagonists	1076	0.02	0.00	0.00	7.89
Olmesartan medoxomil 20mg / Hydrochlorothiazide 12.5mg tab : 23
Formoterol fumarate☰	15	Selective beta(2)-agonists	284	0.05	0.00	0.01	7.39
Formoterol 6micrograms/dose dry powder inhaler : 9 Oxis 6 Turbohaler : 6
Minocycline hydrochloride☰	8	Tetracyclines	112	0.07	0.01	0.01	4.95
Minocycline 100mg tablets : 3 Minocycline 100mg modified-release capsules : 5

Prescribing where Kings Road Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other emollient preparations☰	134	Emollients	232	0.58	0.89	0.07	-4.45
Dermol 500 lotion : 64 Isopropyl myristate 15% / Liquid paraffin 15% gel : 2 Doublebase emollient shower gel : 2 White soft paraffin 95% / Liquid paraffin 5% ointment : 1 Doublebase Dayleve gel : 1 Aveeno cream : 9 White soft paraffin 50% / Liquid paraffin 50% ointment : 13 Dermol cream : 13 Diprobase ointment : 3 Doublebase gel : 6 E45 cream : 10 Oilatum cream : 10
Clopidogrel☰	196	Antiplatelet drugs	1251	0.16	0.32	0.06	-2.62
Clopidogrel 75mg tablets : 193 Plavix 75mg tablets : 3
Carbocisteine☰	41	Mucolytics	53	0.77	0.97	0.08	-2.46
Carbocisteine 375mg capsules : 32 Carbocisteine 250mg/5ml oral solution : 9
Other multivitamin preparations☰	58	Multivitamin preparations	190	0.31	0.81	0.21	-2.43
Valupak Multivitamin One A Day tablets : 14 Forceval Soluble tablets : 8 Dalivit oral drops : 7 Forceval capsules : 10 Abidec Multivitamin drops : 19
Vitamin A☰	0	Vitamin A	3	0.00	0.84	0.35	-2.42