Static outliers for Carlton 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 Carlton Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Mianserin hydrochloride	1	Tricyclic and related antidepressant drugs	224	0.00	0.00	0.00	16.63
Mianserin 30mg tablets : 1
Telmisartan	195	Angiotensin-II receptor antagonists	983	0.20	0.01	0.02	8.14
Telmisartan 80mg tablets : 163 Telmisartan 40mg tablets : 21 Telmisartan 20mg tablets : 11
Olmesartan medoxomil/hydrochlorothiazide	20	Angiotensin-II receptor antagonists	983	0.02	0.00	0.00	7.50
Olmesartan medoxomil 40mg / Hydrochlorothiazide 12.5mg tab : 20
Paraffin soft white	2	Emollients	57	0.04	0.00	0.01	5.99
White soft paraffin solid : 2
Carmellose sodium	13	Tear deficiency, eye lubricant/astringent	17	0.76	0.15	0.10	5.89
Celluvisc 0.5% eye drops 0.4ml unit dose : 2 Carmellose 1% eye drops 0.4ml unit dose preservative free : 1 Carmellose 0.5% eye drops 0.4ml unit dose preservative free : 3 Celluvisc 1% eye drops 0.4ml unit dose : 7

Prescribing where Carlton Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Potassium citrate	0	Drugs used in urological pain	1	0.00	0.93	0.24	-3.87

Procyclidine hydrochloride	2	Antimuscarinic drugs used in parkinsonism	7	0.29	0.84	0.21	-2.67
Procyclidine 5mg tablets : 2
Sodium cromoglicate	2	Other anti-inflammatory preparations	11	0.18	0.67	0.18	-2.66
Opticrom Allergy 2% eye drops : 1 Optrex Allergy 2% eye drops : 1
Morphine sulfate	13	Opioid analgesics	281	0.05	0.20	0.08	-2.00
Morphine sulfate 10mg/5ml oral solution : 1 Oramorph 10mg/5ml oral solution : 9 Morphine sulfate 10mg/1ml solution for injection ampoules : 3
Clopidogrel	196	Antiplatelet drugs	985	0.20	0.32	0.06	-1.95
Clopidogrel 75mg tablets : 196