Static outliers for De Beauvoir 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 De Beauvoir Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Proguanil hydrochloride with atovaquone☰	5	Antimalarials	20	0.25	0.0	0.00	144.78
Malarone 250mg/100mg tablets : 1 Malarone Paediatric 62.5mg/25mg tablets : 1 Proguanil 25mg / Atovaquone 62.5mg tablets : 3
Ramipril with calcium channel blocker☰	18	Angiotensin-converting enzyme inhibitors	855	0.02	0.0	0.00	31.36
Felodipine 5mg modified-release / Ramipril 5mg tablets : 13 Felodipine 2.5mg modified-release / Ramipril 2.5mg tablets : 5
Tolbutamide☰	40	Sulfonylureas	203	0.20	0.0	0.01	18.10
Tolbutamide 500mg tablets : 40
Pilocarpine nitrate☰	7	Treatment of glaucoma	156	0.04	0.0	0.00	15.67
Pilocarpine nitrate 2% eye dps 0.5ml ud preservative free : 7
Methyl salicylate/levomenthol☰	2	Rubefacients, topical NSAIDS, capsaicin and poultice	332	0.01	0.0	0.00	14.57
Methyl salicylate 105mg/Levomenthol 31.5mg : 2

Prescribing where De Beauvoir Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cefalexin☰	12	Cephalosporins	18	0.67	0.96	0.10	-2.86
Cefalexin 250mg capsules : 4 Cefalexin 500mg capsules : 3 Cefalexin 250mg tablets : 5
Medroxyprogesterone acetate☰	11	Parenteral progestogen-only contraceptives	25	0.44	0.88	0.16	-2.71
Sayana Press 104mg/0.65ml inj pre-filled disposable devices : 1 Medroxyprogesterone 150mg/1ml inj pre-filled syringes : 3 Depo-Provera 150mg/1ml inj pre-filled syringes : 7
Glucose☰	2	Treatment of hypoglycaemia	9	0.22	0.75	0.21	-2.55
Glucose 40% oral gel : 1 GlucoGel 40% gel original : 1
Solifenacin☰	5	Drugs for urinary frequency enuresis and incontinence	141	0.04	0.33	0.12	-2.52
Solifenacin 5mg tablets : 1 Solifenacin 10mg tablets : 4
Ciprofloxacin☰	4	Quinolones	8	0.50	0.86	0.15	-2.41
Ciprofloxacin 500mg tablets : 4