Static outliers for Horndon-On-The-Hill 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 Horndon-On-The-Hill Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Saxagliptin/dapagliflozin	20	Other antidiabetic drugs	263	0.08	0.00	0.00	23.72
Saxagliptin 5mg / Dapagliflozin 10mg tablets : 20
Calcium carbonate	5	Compound Alginates and proprietary indigestion preparations	27	0.19	0.00	0.01	15.08
Rennie Orange 500mg chewable tablets : 2 Calcium carbonate 500mg chewable tablets : 3
Olmesartan medoxomil	336	Angiotensin-II receptor antagonists	813	0.41	0.02	0.03	11.66
Olmesartan medoxomil 10mg tablets : 132 Olmesartan medoxomil 20mg tablets : 123 Olmesartan medoxomil 40mg tablets : 80 Olmetec 40mg tablets : 1
Ketotifen fumarate	5	Antihistamines	222	0.02	0.00	0.00	11.61
Ketotifen 1mg tablets : 5
Ketotifen fumarate	4	Other anti-inflammatory preparations	13	0.31	0.02	0.04	8.08
Zaditen 250micrograms/ml eye drops : 4

Prescribing where Horndon-On-The-Hill Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Alginic acid compound preparations	22	Compound Alginates and proprietary indigestion preparations	27	0.81	1.00	0.01	-13.61
Gaviscon Original Aniseed Relief : 2 Gaviscon Advance oral suspension aniseed (Reckitt Benckiser) : 7 Gaviscon Advance oral susp peppermint (Reckitt Benckiser) : 7 Gaviscon Infant oral powder sachets : 6
Neomycin sulfate	1	Nasal preparations for infection	6	0.17	0.84	0.14	-4.67
Naseptin nasal cream : 1
Carbocisteine	14	Mucolytics	21	0.67	0.97	0.08	-3.79
Mucodyne 375mg capsules : 3 Carbocisteine 375mg capsules : 11
Quinine sulfate	18	Antimalarials	47	0.38	0.89	0.14	-3.61
Quinine sulfate 200mg tablets : 12 Quinine sulfate 300mg tablets : 6
Sertraline hydrochloride	136	Selective serotonin re-uptake inhibitors	893	0.15	0.45	0.09	-3.44
Sertraline 50mg tablets : 80 Sertraline 100mg tablets : 54 Sertraline 25mg tablets : 2