Static outliers for Montpelier Surgery

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 Montpelier Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Timolol☰	9	Beta-adrenoceptor blocking drugs	850	0.01	0.00	0.00	7.30
Timolol 10mg tablets : 9
Hyoscine☰	23	Drugs used in nausea and vertigo	143	0.16	0.02	0.02	5.75
Hyoscine 1mg/72hours transdermal patches : 23
Colesevelam hydrochloride☰	18	Lipid-regulating drugs	1344	0.01	0.00	0.00	5.01
Cholestagel 625mg tablets : 1 Colesevelam 625mg tablets : 17
Sacubitril/valsartan☰	30	Angiotensin-II receptor antagonists	265	0.11	0.02	0.02	4.46
Sacubitril 49mg / Valsartan 51mg tablets : 2 Sacubitril 24mg / Valsartan 26mg tablets : 28
Glycopyrronium bromide☰	11	Antispasmodic and other drugs altering gut motility	73	0.15	0.02	0.03	4.37
Glycopyrronium bromide 2mg tablets : 4 Glycopyrronium bromide 1mg tablets : 4 Glycopyrronium bromide 1mg/5ml oral solution sugar free : 3

Prescribing where Montpelier Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other multivitamin preparations☰	10	Multivitamin preparations	142	0.07	0.81	0.21	-3.55
Paravit-cf capsules : 3 Multivitamin tablets : 7
Procyclidine hydrochloride☰	4	Antimuscarinic drugs used in parkinsonism	31	0.13	0.84	0.21	-3.42
Kemadrin 5mg tablets : 4
Chloramphenicol☰	14	Antibacterials	37	0.38	0.78	0.13	-3.10
Chloramphenicol 0.5% eye drops preservative free : 1 Chloramphenicol 0.5% eye drops : 8 Chloramphenicol 1% eye ointment : 5
Carbimazole☰	5	Antithyroid drugs	8	0.62	0.93	0.11	-2.89
Carbimazole 20mg tablets : 2 Carbimazole 10mg tablets : 2 Carbimazole 15mg tablets : 1
Tacrolimus☰	4	Drugs affecting the immune response	15	0.27	0.81	0.21	-2.61
Protopic 0.03% ointment : 1 Tacrolimus 0.1% ointment : 3