Static outliers for Staunton 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 Staunton Group Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Saxagliptin/metformin	119	Other antidiabetic drugs	2472	0.05	0.00	0.00	15.14
Saxagliptin 2.5mg / Metformin 1g tablets : 114 Saxagliptin 2.5mg / Metformin 850mg tablets : 5
Naldemedine	1	Peripheral opioid-receptor antagonists	1	1.00	0.03	0.14	6.74
Naldemedine 200microgram tablets : 1
Entacapone	26	Dopaminergic drugs used in parkinsonism	186	0.14	0.01	0.02	5.94
Entacapone 200mg tablets : 26
Celiprolol hydrochloride	24	Beta-adrenoceptor blocking drugs	3262	0.01	0.00	0.00	4.44
Celiprolol 400mg tablets : 24
Methyl salicylate	37	Rubefacients, topical NSAIDS, capsaicin and poultice	639	0.06	0.00	0.01	3.96
Balmosa cream : 32 Methyl salicylate 30% / Menthol 8% cream : 1 Deep Heat Maximum Strength cream : 4

Prescribing where Staunton Group Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Naloxegol	0	Peripheral opioid-receptor antagonists	1	0.00	0.97	0.15	-6.30

Methylphenidate hydrochloride	11	CNS Stimulants and drugs used for ADHD	64	0.17	0.65	0.21	-2.32
Methylphenidate 10mg tablets : 4 Equasym XL 30mg capsules : 4 Concerta XL 54mg tablets : 3
Quinine sulfate	94	Antimalarials	159	0.59	0.89	0.14	-2.13
Quinine sulfate 200mg tablets : 80 Quinine sulfate 300mg tablets : 14
Lidocaine hydrochloride	11	Local anaesthetics	18	0.61	0.91	0.14	-2.13
Instillagel gel : 2 Bonjela Junior gel : 2 Lidocaine 2% and Chlorhexidine gel : 1 Emla 5% cream : 6
Bendroflumethiazide	201	Thiazides and related diuretics	805	0.25	0.58	0.16	-2.07
Bendroflumethiazide 2.5mg tablets : 201