Static outliers for Newham Medical Centre

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 Newham Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nateglinide☰	3	Other antidiabetic drugs	3056	0.00	0.00	0.00	20.30
Nateglinide 60mg tablets : 3
Low protein cakes☰	14	Foods for special diets	135	0.10	0.00	0.01	19.36
Taranis low protein lemon cake : 14
Gluten free/low protein biscuits☰	27	Foods for special diets	135	0.20	0.00	0.01	17.98
Mevalia low protein fruit bar : 12 Mevalia low protein cookies : 15
Lithium citrate☰	19	Drugs used for mania and hypomania	43	0.44	0.01	0.03	17.00
Priadel 520mg/5ml liquid : 19
Disopyramide☰	6	Drugs for arrhythmias	6	1.00	0.02	0.06	15.45
Disopyramide 100mg capsules : 6

Prescribing where Newham Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Potassium chloride☰	1	Oral potassium	5	0.20	0.98	0.12	-6.60
Sando-K effervescent tablets : 1
Prednisolone☰	169	Use of corticosteroids	247	0.68	0.88	0.06	-3.10
Prednisolone 5mg tablets : 144 Prednisolone 1mg tablets : 9 Prednisolone 5mg soluble tablets : 4 Prednisolone 5mg gastro-resistant tablets : 7 Prednisolone 2.5mg gastro-resistant tablets : 5
Baclofen☰	10	Skeletal muscle relaxants	39	0.26	0.83	0.18	-3.10
Baclofen 10mg tablets : 10
Diazepam☰	16	Anxiolytics	41	0.39	0.75	0.14	-2.68
Diazepam 5mg tablets : 8 Diazepam 2mg tablets : 3 Diazepam 10mg/2.5ml rectal solution tube : 5
Budesonide☰	0	Corticosteroids	1	0.00	0.70	0.34	-2.08