Static outliers for Mount Avenue 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 Mount Avenue Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Trimipramine maleate☰	16	Tricyclic and related antidepressant drugs	665	0.02	0.00	0.00	5.32
Trimipramine 50mg capsules : 1 Trimipramine 25mg tablets : 8 Trimipramine 10mg tablets : 7
Magnesium oxide☰	2	Antacids and simeticone	2	1.00	0.05	0.19	5.07
Magnesium oxide 160mg capsules : 2
Dexamethasone sodium phosphate☰	1	Use of corticosteroids	475	0.00	0.00	0.00	4.34
Dexamethasone (base) 3.8mg/1ml solution for injection vials : 1
Rutosides☰	3	Peripheral vasodilators and related drugs	4	0.75	0.06	0.19	3.63
Oxerutins 250mg capsules : 3
Acetylcysteine☰	10	Tear deficiency, eye lubricant/astringent	135	0.07	0.01	0.02	3.52
Acetylcysteine 5% eye drops : 3 Ilube 5% eye drops : 7

Prescribing where Mount Avenue Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Hydroxycarbamide☰	16	Other antineoplastic drugs	17	0.94	1.00	0.02	-3.25
Hydroxycarbamide 500mg capsules : 13 Hydrea 500mg capsules : 3
Hyoscine butylbromide☰	13	Antispasmodic and other drugs altering gut motility	154	0.08	0.33	0.12	-2.09
Hyoscine butylbromide 20mg/1ml inj ampoules : 1 Buscopan 20mg/1ml solution for injection ampoules : 1 Hyoscine butylbromide 10mg tablets : 8 Buscopan 10mg tablets : 3
Spironolactone☰	97	Potassium-sparing diuretics and aldosterone antagonists	208	0.47	0.72	0.14	-1.84
Spironolactone 25mg tablets : 84 Spironolactone 100mg tablets : 2 Spironolactone 50mg tablets : 11
Sumatriptan succinate☰	101	Treatment of acute migraine	224	0.45	0.67	0.12	-1.77
Sumatriptan 100mg tablets : 43 Sumatriptan 50mg tablets : 51 Sumatriptan 10mg/0.1ml nasal spray unit dose : 1 Imigran 100mg tablets : 1 Sumatriptan 6mg/0.5ml inj pre-filled syringes with device : 5
Quinine sulfate☰	45	Antimalarials	70	0.64	0.89	0.14	-1.77
Quinine sulfate 200mg tablets : 31 Quinine sulfate 300mg tablets : 14