Static outliers for Angel Lane 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 Angel Lane Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Saxagliptin	410	Other antidiabetic drugs	1096	0.37	0.01	0.02	14.69
Saxagliptin 5mg tablets : 358 Saxagliptin 2.5mg tablets : 47 Onglyza 5mg tablets : 5
Acitretin	20	Preparations for psoriasis	113	0.18	0.00	0.02	8.91
Acitretin 10mg capsules : 20
Co-tenidone (Atenolol/chlortalidone)	122	Beta-adrenoceptor blocking drugs	3887	0.03	0.00	0.01	5.61
Co-tenidone 50mg/12.5mg tablets : 67 Co-tenidone 100mg/25mg tablets : 49 Tenoret 50mg/12.5mg tablets : 6
Paliperidone	2	Antipsychotic depot injections	2	1.00	0.09	0.22	4.15
Paliperidone 150mg/1.5ml inj pre-filled syringes : 2
Tizanidine hydrochloride	14	Skeletal muscle relaxants	30	0.47	0.07	0.10	3.89
Tizanidine 2mg tablets : 4 Tizanidine 4mg tablets : 10

Prescribing where Angel Lane Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Procyclidine hydrochloride	31	Antimuscarinic drugs used in parkinsonism	74	0.42	0.84	0.21	-2.04
Procyclidine 5mg tablets : 31
Loperamide hydrochloride	117	Antimotility drugs	120	0.98	1.00	0.01	-1.92
Loperamide 2mg capsules : 91 Loperamide 2mg tablets : 6 Loperamide 1mg/5ml oral solution sugar free : 15 Imodium 1mg/5ml oral solution : 5
Ivermectin	10	Topical preparation for rosacea	23	0.43	0.88	0.24	-1.87
Ivermectin 10mg/g cream : 1 Soolantra 10mg/g cream : 9
Tacrolimus	10	Drugs affecting the immune response	22	0.45	0.81	0.21	-1.70
Protopic 0.03% ointment : 2 Tacrolimus 0.1% ointment : 4 Protopic 0.1% ointment : 4
Baclofen	16	Skeletal muscle relaxants	30	0.53	0.83	0.18	-1.59
Baclofen 10mg tablets : 13 Baclofen 5mg/5ml oral solution sugar free : 3