Static outliers for Collingwood Road 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 Collingwood Road Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Acebutolol hydrochloride☰	6	Beta-adrenoceptor blocking drugs	471	0.01	0.00	0.00	20.36
Acebutolol 400mg tablets : 6
Iron and folic acid☰	9	Oral iron	128	0.07	0.00	0.01	11.23
Ferrous sulfate 325mg / Folic acid 350microgram MR tab : 3 Ferrograd Folic 325mg/350microgram modified-release tablets : 6
Clobetasol propionate☰	60	Topical corticosteroids	169	0.36	0.08	0.03	8.59
Clobetasol 0.05% ointment : 33 Clobetasol 0.05% cream : 1 Dermovate 0.05% cream : 3 Clobetasol 0.05% scalp application : 7 Dermovate 0.05% ointment : 11 Dermovate 0.05% scalp application : 5
Propantheline bromide☰	6	Antispasmodic and other drugs altering gut motility	40	0.15	0.01	0.02	5.93
Propantheline bromide 15mg tablets : 6
Silver nitrate☰	1	Preparations for warts and calluses	1	1.00	0.07	0.17	5.62
Silver nitrate 40% caustic pencils : 1

Prescribing where Collingwood Road Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sumatriptan succinate☰	10	Treatment of acute migraine	51	0.20	0.67	0.12	-3.87
Sumatriptan 10mg/0.1ml nasal spray unit dose : 1 Sumatriptan 50mg tablets : 9
Hydrocortisone☰	20	Topical corticosteroids	169	0.12	0.34	0.06	-3.46
Hydrocortisone 1% ointment : 2 Timodine cream : 2 Daktacort 2%/1% cream : 1 Hydrocortisone 1% / Miconazole 2% ointment : 3 Hydrocortisone 1% cream : 7 Hydrocortisone 0.5% cream : 5
Sodium cromoglicate☰	2	Other anti-inflammatory preparations	11	0.18	0.67	0.18	-2.66
Sodium cromoglicate 2% eye drops preservative free : 1 Opticrom Hayfever 2% eye drops : 1
Emollient bath and shower preparations☰	1	Emollient bath and shower preparations	18	0.06	0.61	0.21	-2.62
Dermol 200 shower emollient : 1
Theophylline☰	3	Theophylline	13	0.23	0.83	0.25	-2.44
Theophylline 200mg modified-release tablets : 3