Static outliers for Charter 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 Charter Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Tolvaptan☰	5	Posterior pituitary hormones and antagonists	29	0.17	0.00	0.01	20.66
Tolvaptan 7.5mg tablets : 5
Phosphates☰	1	Bowel cleansing preparations	1	1.00	0.01	0.07	14.58
Phospho-soda 24.4g/10.8g oral solution : 1
Dipyridamole and aspirin☰	1	Antiplatelet drugs	3141	0.00	0.00	0.00	14.16
Dipyridamole 200mg modified-release / Aspirin 25mg capsules : 1
Alclometasone dipropionate☰	1	Topical corticosteroids	1446	0.00	0.00	0.00	6.53
Alclometasone 0.05% cream : 1
Brivaracetam☰	110	Control of epilepsy	4884	0.02	0.00	0.00	5.46
Brivaracetam 50mg tablets : 35 Brivaracetam 100mg tablets : 43 Brivaracetam 75mg tablets : 2 Brivaracetam 50mg/5ml oral solution sugar free : 6 Brivaracetam 25mg tablets : 24

Prescribing where Charter Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Desmopressin acetate☰	24	Posterior pituitary hormones and antagonists	29	0.83	1.00	0.01	-20.66
Desmopressin 100microgram tablets : 2 Desmopressin 200microgram tablets : 9 Desmopressin 10micrograms/dose nasal spray : 4 DesmoMelt 120microgram oral lyophilisates : 3 Desmopressin 120microgram oral lyophilisates sugar free : 6
Other multivitamin preparations☰	97	Multivitamin preparations	503	0.19	0.81	0.21	-2.96
Forceval capsules : 30 Renavit tablets : 43 Dalivit oral drops : 13 Multivitamin tablets : 8 Abidec Multivitamin drops : 3
Co-cyprindiol (Cyprote acetate/ethinylestradiol)☰	2	Oral preparations for acne	3	0.67	0.97	0.13	-2.27
Dianette tablets (Bayer) : 2
Furosemide☰	1074	Loop diuretics	1533	0.70	0.86	0.09	-1.74
Furosemide 20mg tablets : 512 Furosemide 40mg tablets : 552 Furosemide 40mg/5ml oral solution sugar free : 10
Gentamicin sulfate☰	0	Aminoglycosides	1	0.00	0.72	0.44	-1.65