Static outliers for Dr Km Alkaisy Practice

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 Dr Km Alkaisy Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Linagliptin/metformin	460	Other antidiabetic drugs	1367	0.34	0.00	0.01	25.37
Linagliptin 2.5mg / Metformin 1g tablets : 455 Jentadueto 2.5mg/1000mg tablets : 5
Sulfadiazine	1	Sulfonamides and trimethoprim	45	0.02	0.00	0.00	13.52
Sulfadiazine 500mg tablets : 1
Piroxicam	202	Rubefacients, topical NSAIDS, capsaicin and poultice	235	0.86	0.05	0.09	8.89
Piroxicam 0.5% gel : 194 Feldene 0.5% gel : 8
Oestrogens conjugated with progestogen	7	Oestrogens and Hormone Replacement Therapy	34	0.21	0.01	0.02	8.73
Premique Low Dose 0.3mg/1.5mg modified-release tablets : 7
Selenium sulfide	5	Shampoos and some other scalp preparations	16	0.31	0.03	0.05	6.09
Selenium sulfide 2.5% shampoo : 5

Prescribing where Dr Km Alkaisy Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Potassium citrate	0	Drugs used in urological pain	10	0.00	0.93	0.24	-3.87

Diazepam	54	Anxiolytics	167	0.32	0.75	0.14	-3.17
Diazepam 2mg tablets : 44 Diazepam 5mg/2.5ml rectal solution tube : 1 Diazepam 10mg/2.5ml rectal solution tube : 3 Diazepam 5mg tablets : 6
Clotrimazole	14	Vaginal and vulval infections	22	0.64	0.90	0.10	-2.74
Clotrimazole 500mg pessaries : 2 Clotrimazole 200mg pessaries : 1 Clotrimazole 10% vaginal cream : 1 Clotrimazole 2% cream : 5 Clotrimazole 500mg pessary and Clotrimazole 2% cream : 5
Estradiol	3	Oestrogens and Hormone Replacement Therapy	34	0.09	0.46	0.14	-2.64
Estradiol 0.06% gel (750microgram per actuation) : 2 Evorel 25 patches : 1
Aciclovir	19	Herpes simplex and varicella-zoster	24	0.79	0.95	0.07	-2.36
Aciclovir 200mg tablets : 2 Aciclovir 400mg/5ml oral suspension sugar free : 2 Aciclovir 800mg tablets : 1 Aciclovir 400mg tablets : 9 Aciclovir 200mg dispersible tablets : 5