Static outliers for Earls Court 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 Earls Court Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Bumetanide☰	78	Loop diuretics	113	0.69	0.14	0.09	6.15
Bumetanide 1mg tablets : 78
Sterculia☰	15	Bulk-forming laxatives	31	0.48	0.04	0.07	6.11
Normacol granules 7g sachets : 1 Normacol Plus granules 7g sachets : 8 Sterculia 62% granules gluten free : 6
Aspirin☰	6	Non-opioid analgesics and compound preparations	345	0.02	0.00	0.00	6.08
Aspirin 300mg dispersible tablets : 6
Dipyridamole☰	27	Antiplatelet drugs	600	0.04	0.01	0.01	6.03
Dipyridamole 200mg modified-release capsules : 27
Ibandronic acid☰	15	Bisphosphonates and other drugs	68	0.22	0.02	0.03	5.87
Ibandronic acid 150mg tablets : 15

Prescribing where Earls Court Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Furosemide☰	35	Loop diuretics	113	0.31	0.86	0.09	-6.10
Furosemide 40mg tablets : 23 Furosemide 20mg tablets : 12
Ispaghula husk☰	16	Bulk-forming laxatives	31	0.52	0.96	0.07	-6.04
Ispaghula husk 3.5g efferv gran sach gluten free sugar free : 9 Fybogel Hi-Fibre Orange 3.5g effervescent granules sachets : 4 Fybogel Orange 3.5g effervescent granules sachets SF : 3
Procyclidine hydrochloride☰	0	Antimuscarinic drugs used in parkinsonism	5	0.00	0.84	0.21	-4.04
Nitrofurantoin☰	37	Urinary-tract infections	47	0.79	0.97	0.06	-2.94
Nitrofurantoin 100mg modified-release capsules : 33 Nitrofurantoin 50mg capsules : 2 Nitrofurantoin 100mg tablets : 2
Other multivitamin preparations☰	7	Multivitamin preparations	35	0.20	0.81	0.21	-2.93
Forceval capsules : 4 Abidec Multivitamin drops : 3