Static outliers for The Pinn Medical 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 The Pinn Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sodium benzoate☰	1	Mouth-washes, gargles and dentifrices	7	0.14	0.00	0.01	16.25
Mouthwash solution tablets : 1
Tiaprofenic acid☰	6	Non-steroidal anti-inflammatory drugs	566	0.01	0.00	0.00	15.18
Tiaprofenic acid 300mg tablets : 6
Atenolol with calcium channel blocker☰	38	Beta-adrenoceptor blocking drugs	4287	0.01	0.00	0.00	9.34
Tenif 50mg/20mg modified-release capsules : 38
Rufinamide☰	24	Control of epilepsy	2203	0.01	0.00	0.00	6.68
Rufinamide 400mg tablets : 12 Rufinamide 100mg tablets : 6 Rufinamide 200mg tablets : 6
Lithium citrate☰	11	Drugs used for mania and hypomania	69	0.16	0.01	0.03	5.99
Priadel 520mg/5ml liquid : 11

Prescribing where The Pinn Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Acamprosate calcium☰	0	Alcohol dependence	1	0.00	0.83	0.31	-2.70
Co-cyprindiol (Cyprote acetate/ethinylestradiol)☰	4	Oral preparations for acne	6	0.67	0.97	0.13	-2.27
Co-cyprindiol 2000microgram/35microgram tablets : 1 Dianette tablets (Bayer) : 3
Ispaghula husk☰	84	Bulk-forming laxatives	104	0.81	0.96	0.07	-2.09
Ispaghula husk 3.5g efferv gran sach gluten free sugar free : 48 Ispagel Orange 3.5g effervescent granules sachets : 1 Fybogel Hi-Fibre Orange 3.5g effervescent granules sachets : 8 Fybogel 3.5g effervescent granules sachets plain SF : 3 Fybogel Orange 3.5g effervescent granules sachets SF : 24
Gabapentin☰	204	Control of epilepsy	2203	0.09	0.24	0.08	-1.79
Gabapentin 100mg capsules : 53 Gabapentin 300mg capsules : 130 Gabapentin 400mg capsules : 9 Gabapentin 600mg tablets : 12
Permethrin☰	2	Parasiticidal preparations	5	0.40	0.84	0.25	-1.75
Permethrin 5% cream : 2