Static outliers for Islip Manor 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 Islip Manor Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Methadone hydrochloride☰	34	Opioid analgesics	207	0.16	0.00	0.00	42.91
Physeptone 5mg tablets : 34
Benzylpenicillin sodium (Penicillin G)☰	1	Benzylpenicillin and phenoxymethylpenicillin	25	0.04	0.00	0.00	36.58
Benzylpenicillin 1.2g inj vials : 1
Oxcarbazepine☰	44	Control of epilepsy	661	0.07	0.00	0.01	9.18
Oxcarbazepine 300mg tablets : 22 Oxcarbazepine 600mg tablets : 22
Rivastigmine☰	21	Drugs for dementia	25	0.84	0.10	0.10	7.24
Rivastigmine 13.3mg/24hours transdermal patches : 21
Acetylcysteine☰	6	Tear deficiency, eye lubricant/astringent	45	0.13	0.01	0.02	6.73
Ilube 5% eye drops : 6

Prescribing where Islip Manor Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Phenoxymethylpenicillin (Penicillin V)☰	24	Benzylpenicillin and phenoxymethylpenicillin	25	0.96	1.00	0.00	-36.58
Phenoxymethylpenicillin 250mg/5ml oral solution sugar free : 2 Phenoxymethylpenicillin 125mg/5ml oral solution : 4 Phenoxymethylpenicillin 125mg/5ml oral solution sugar free : 4 Phenoxymethylpenicillin 250mg/5ml oral solution : 3 Phenoxymethylpenicillin 250mg tablets : 11
Ivermectin☰	0	Topical preparation for rosacea	1	0.00	0.88	0.24	-3.72
Furosemide☰	140	Loop diuretics	229	0.61	0.86	0.09	-2.73
Furosemide 40mg tablets : 120 Furosemide 20mg tablets : 20
Simvastatin☰	72	Lipid-regulating drugs	1720	0.04	0.22	0.08	-2.38
Simvastatin 10mg tablets : 30 Simvastatin 40mg tablets : 26 Simvastatin 20mg tablets : 16
Clopidogrel☰	117	Antiplatelet drugs	646	0.18	0.32	0.06	-2.23
Clopidogrel 75mg tablets : 117