Static outliers for The Rise Group 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 The Rise Group Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Felbinac☰	7	Rubefacients, topical NSAIDS, capsaicin and poultice	235	0.03	0.0	0.00	28.59
Felbinac 3% gel : 7
Sodium clodronate☰	6	Bisphosphonates and other drugs	104	0.06	0.0	0.01	11.15
Sodium clodronate 400mg capsules : 6
Probenecid☰	1	Gout and cytotoxic induced hyperiuicaemia	125	0.01	0.0	0.00	9.60
Probenecid 500mg tablets : 1
Paraffin soft white☰	10	Emollients	196	0.05	0.0	0.01	8.86
White soft paraffin solid : 5 Dermamist 10% spray : 5
Rufinamide☰	10	Control of epilepsy	828	0.01	0.0	0.00	7.43
Rufinamide 100mg tablets : 5 Rufinamide 400mg tablets : 5

Prescribing where The Rise Group Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Desogestrel☰	38	Oral progestogen-only contraceptives	55	0.69	0.94	0.05	-4.56
Cerazette 75microgram tablets : 2 Zelleta 75microgram tablets : 1 Desogestrel 75microgram tablets : 28 Cerelle 75microgram tablets : 7
Theophylline☰	0	Theophylline	2	0.00	0.83	0.25	-3.38
Other emollient preparations☰	133	Emollients	196	0.68	0.89	0.07	-3.01
Ultrabase cream : 38 Dermol 500 lotion : 52 Doublebase gel : 2 Doublebase emollient shower gel : 1 Aveeno cream : 14 E45 cream : 8 White soft paraffin 50% / Liquid paraffin 50% ointment : 7 Diprobase ointment : 6 Aveeno moisturising creamy oil : 5
Fusidic acid☰	2	Antibacterial preparations also used systemically	7	0.29	0.72	0.15	-2.85
Fusidic acid 2% cream : 1 Fucidin 20mg/g cream : 1
Tamsulosin hydrochloride☰	150	Drugs for urinary retention	199	0.75	0.92	0.06	-2.70
Tamsulosin 400microgram modified-release capsules : 147 Tamsulosin 400microgram modified-release tablets : 3