Static outliers for The Barnabas Medical Ctre

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 Barnabas Medical Ctre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Flunarizine dihydrochloride☰	5	Drugs used in nausea and vertigo	211	0.02	0.00	0.00	14.26
Flunarizine 5mg capsules : 5
Omega-3-acid ethyl esters☰	54	Lipid-regulating drugs	3025	0.02	0.00	0.00	7.64
Omacor capsules : 33 Eicosapentaenoic acid 460mg/Docosahexaenoic acid 380mg caps : 21
Tapentadol hydrochloride☰	57	Opioid analgesics	486	0.12	0.01	0.02	6.26
Tapentadol 100mg modified-release tablets : 34 Tapentadol 50mg tablets : 18 Tapentadol 50mg modified-release tablets : 5
Flupentixol hydrochloride☰	40	Other antidepressant drugs	493	0.08	0.01	0.01	6.08
Flupentixol 500microgram tablets : 20 Flupentixol 1mg tablets : 20
Eletriptan☰	10	Treatment of acute migraine	117	0.09	0.00	0.01	5.60
Eletriptan 40mg tablets : 10

Prescribing where The Barnabas Medical Ctre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Water for injection☰	1	Electrolytes and water	6	0.17	0.82	0.26	-2.50
Water for injections 10ml vials : 1
Famotidine☰	4	H2-Receptor antagonists	15	0.27	0.78	0.23	-2.20
Famotidine 20mg tablets : 4
Chloramphenicol☰	37	Antibacterials	72	0.51	0.78	0.13	-2.06
Chloramphenicol 0.5% eye drops : 14 Chloramphenicol 1% eye ointment : 23
Fluconazole☰	14	Triazole antifungals	25	0.56	0.85	0.15	-1.97
Fluconazole 150mg capsules : 9 Fluconazole 50mg capsules : 5
Nicorandil☰	13	Other antianginal drugs	116	0.11	0.51	0.20	-1.94
Nicorandil 10mg tablets : 13