Static outliers for The Summitt 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 Summitt Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Testosterone enantate	7	Male sex hormones and antagonists	16	0.44	0.00	0.01	67.92
Testosterone enantate 250mg/1ml inj ampoules : 7
Felbinac	8	Rubefacients, topical NSAIDS, capsaicin and poultice	144	0.06	0.00	0.00	53.41
Felbinac 3% gel : 8
Almotriptan	6	Treatment of acute migraine	7	0.86	0.01	0.02	35.81
Almotriptan 12.5mg tablets : 6
Dexamethasone sodium metasulphobenzoate	2	Otitis externa	3	0.67	0.04	0.05	12.39
Sofradex ear/eye drops : 2
Betamethasone esters	43	Topical corticosteroids	137	0.31	0.03	0.02	11.88
Diprosalic 0.05%/3% ointment : 35 Betamethasone diprop 0.05%/Salicylic acid 2% scalp applic : 2 Betamethasone dipropionate 0.05% cream : 1 Betamethasone dipropionate 0.05% / Salicylic acid 3% oint : 5

Prescribing where The Summitt Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Prednisolone	9	Use of corticosteroids	24	0.38	0.88	0.06	-8.02
Prednisolone 2.5mg gastro-resistant tablets : 2 Prednisolone 1mg tablets : 1 Prednisolone 5mg tablets : 6
Diazepam	2	Anxiolytics	36	0.06	0.75	0.14	-5.15
Diazepam 2mg tablets : 2
Sumatriptan succinate	1	Treatment of acute migraine	7	0.14	0.67	0.12	-4.31
Sumatriptan 50mg tablets : 1
Hydrocortisone	15	Topical corticosteroids	137	0.11	0.34	0.06	-3.59
Hydrocortisone 0.5% ointment : 2 Timodine cream : 2 Daktacort 2%/1% cream : 1 Hydrocortisone 1% ointment : 4 Hydrocortisone 1% cream : 3 Hydrocortisone 1% / Miconazole 2% cream : 3
Dexamethasone	1	Otitis externa	3	0.33	0.78	0.13	-3.40
Otomize ear spray : 1