Static outliers for St. Peter'S 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 St. Peter'S Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Alclometasone dipropionate☰	2	Topical corticosteroids	874	0.00	0.0	0.00	21.76
Alclometasone 0.05% cream : 2
Ketoprofen☰	50	Non-steroidal anti-inflammatory drugs	1091	0.05	0.0	0.00	13.72
Ketoprofen 100mg modified-release capsules : 49 Oruvail 200 modified-release capsules : 1
Fluocortolone☰	7	Copound haemorrhoidal preparations with corticosteroid	103	0.07	0.0	0.01	13.13
Ultraproct suppositories : 7
Nystatin☰	2	Vaginal and vulval infections	98	0.02	0.0	0.00	9.54
Nystatin 100,000unit pessaries : 2
Diazoxide☰	19	Treatment of hypoglycaemia	68	0.28	0.0	0.04	7.65
Diazoxide 50mg/5ml oral suspension : 1 Diazoxide 50mg tablets : 18

Prescribing where St. Peter'S Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Azathioprine☰	63	Antiproliferative immunosuppressants	153	0.41	0.80	0.19	-2.11
Azathioprine 50mg tablets : 34 Imuran 50mg tablets : 8 Azathioprine 25mg tablets : 21
Zopiclone☰	698	Hypnotics	2208	0.32	0.60	0.14	-2.05
Zopiclone 7.5mg tablets : 447 Zopiclone 3.75mg tablets : 251
Medroxyprogesterone acetate☰	40	Parenteral progestogen-only contraceptives	68	0.59	0.88	0.16	-1.80
Depo-Provera 150mg/1ml inj pre-filled syringes : 36 Sayana Press 104mg/0.65ml inj pre-filled disposable devices : 4
Furosemide☰	1018	Loop diuretics	1457	0.70	0.86	0.09	-1.76
Furosemide 20mg tablets : 313 Furosemide 40mg tablets : 682 Furosemide 40mg/5ml oral solution sugar free : 3 Furosemide 20mg/5ml oral solution sugar free : 20
Naftidrofuryl oxalate☰	0	Peripheral vasodilators and related drugs	1	0.00	0.66	0.39	-1.69