Static outliers for Thornbury Road Centre For Health

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 Thornbury Road Centre For Health is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Pridinol mesilate☰	2	Skeletal muscle relaxants	11	0.18	0.00	0.01	18.99
Pridinol 3mg tablets : 2
Magnesium trisilicate☰	20	Antacids and simeticone	20	1.00	0.03	0.14	7.11
Magnesium trisilicate compound tablets : 20
Acipimox☰	5	Lipid-regulating drugs	5720	0.00	0.00	0.00	6.93
Acipimox 250mg capsules : 5
Cimetidine☰	32	H2-Receptor antagonists	34	0.94	0.08	0.15	5.84
Cimetidine 200mg/5ml oral solution : 6 Cimetidine 200mg/5ml oral solution sugar free : 6 Cimetidine 400mg tablets : 20
Co-dydramol (Dihydrocodeine/paracetamol)☰	252	Non-opioid analgesics and compound preparations	791	0.32	0.05	0.06	4.71
Co-dydramol 10mg/500mg tablets : 229 Co-dydramol 30mg/500mg tablets : 23

Prescribing where Thornbury Road Centre For Health is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Permethrin☰	0	Parasiticidal preparations	1	0.00	0.84	0.25	-3.32
Quinine sulfate☰	29	Antimalarials	65	0.45	0.89	0.14	-3.16
Quinine sulfate 300mg tablets : 13 Quinine sulfate 200mg tablets : 16
Famotidine☰	2	H2-Receptor antagonists	34	0.06	0.78	0.23	-3.08
Famotidine 20mg tablets : 2
Spironolactone☰	79	Potassium-sparing diuretics and aldosterone antagonists	201	0.39	0.72	0.14	-2.37
Spironolactone 25mg tablets : 73 Spironolactone 100mg tablets : 2 Spironolactone 50mg tablets : 4
Prucalopride☰	0	Other drugs used in constipation	4	0.00	0.71	0.33	-2.18