Static outliers for Gordon 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 Gordon House Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Methadone hydrochloride☰	58	Opioid analgesics	849	0.07	0.00	0.00	17.74
Methadone 5mg tablets : 58
Dicycloverine hydrochloride☰	25	Antispasmodic and other drugs altering gut motility	210	0.12	0.01	0.01	8.38
Dicycloverine 20mg tablets : 1 Dicycloverine 10mg tablets : 24
Econazole nitrate☰	9	Vaginal and vulval infections	41	0.22	0.01	0.03	6.48
Econazole 1% cream : 1 Econazole 150mg pessaries : 8
Estradiol and nomegestrol☰	3	Combined hormonal contraceptives	214	0.01	0.00	0.00	5.71
Zoely 2.5mg/1.5mg tablets : 3
Omega-3-acid ethyl esters☰	85	Lipid-regulating drugs	6851	0.01	0.00	0.00	5.15
Eicosapentaenoic acid 460mg/Docosahexaenoic acid 380mg caps : 52 Omacor capsules : 33

Prescribing where Gordon House Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sildenafil (Erectile Dysfunction)☰	117	Drugs for erectile dysfunction	258	0.45	0.77	0.09	-3.35
Sildenafil 50mg tablets : 36 Sildenafil 100mg tablets : 70 Sildenafil 25mg tablets : 6 Viagra 50mg tablets : 5
Water for injection☰	2	Electrolytes and water	35	0.06	0.82	0.26	-2.92
Water for injections 10ml vials : 2
Furosemide☰	482	Loop diuretics	732	0.66	0.86	0.09	-2.21
Furosemide 20mg tablets : 196 Furosemide 40mg tablets : 281 Furosemide 20mg/5ml oral solution sugar free : 1 Furosemide 40mg/5ml oral solution sugar free : 4
Clotrimazole☰	29	Vaginal and vulval infections	41	0.71	0.90	0.10	-2.01
Clotrimazole 100mg pessaries : 1 Clotrimazole 500mg pessaries : 1 Canesten Combi 500mg pessary and 2% cream : 1 Clotrimazole 200mg pessaries : 4 Clotrimazole 500mg pessary and Clotrimazole 2% cream : 12 Clotrimazole 2% cream : 10
Permethrin☰	1	Parasiticidal preparations	3	0.33	0.84	0.25	-2.01
Permethrin 5% cream : 1