Static outliers for Lawford 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 Lawford Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Rosuvastatin calcium	1463	Lipid-regulating drugs	3550	0.41	0.04	0.02	15.85
Rosuvastatin 10mg tablets : 945 Rosuvastatin 20mg tablets : 172 Rosuvastatin 5mg tablets : 346
Dexpanthenol	9	Emollients	218	0.04	0.00	0.01	6.43
Bepanthen Nappy Care 5% ointment : 9
Mupirocin	12	Nasal preparations for infection	14	0.86	0.16	0.14	4.84
Bactroban 2% nasal ointment : 1 Mupirocin 2% nasal ointment : 11
Rizatriptan	61	Treatment of acute migraine	129	0.47	0.10	0.08	4.79
Rizatriptan 10mg tablets : 9 Rizatriptan 10mg orodispersible tablets sugar free : 21 Rizatriptan 10mg oral lyophilisates sugar free : 16 Maxalt Melt 10mg oral lyophilisates : 15
Trihexyphenidyl hydrochloride	1	Antimuscarinic drugs used in parkinsonism	1	1.00	0.15	0.21	4.14
Trihexyphenidyl 5mg tablets : 1

Prescribing where Lawford Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Neomycin sulfate	2	Nasal preparations for infection	14	0.14	0.84	0.14	-4.84
Neomycin 0.5% / Chlorhexidine hydrochloride 0.1% cream : 1 Naseptin nasal cream : 1
Procyclidine hydrochloride	0	Antimuscarinic drugs used in parkinsonism	1	0.00	0.84	0.21	-4.04

Atorvastatin	1284	Lipid-regulating drugs	3550	0.36	0.66	0.08	-3.64
Atorvastatin 10mg tablets : 199 Atorvastatin 20mg tablets : 556 Atorvastatin 40mg tablets : 413 Atorvastatin 80mg tablets : 116
Hyoscine butylbromide	1	Antispasmodic and other drugs altering gut motility	64	0.02	0.33	0.12	-2.67
Hyoscine butylbromide 10mg tablets : 1
Carbimazole	13	Antithyroid drugs	19	0.68	0.93	0.11	-2.33
Carbimazole 20mg tablets : 2 Carbimazole 5mg tablets : 11