Static outliers for Balmoral 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 Balmoral Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cyproterone acetate☰	5	Male sex hormones and antagonists	247	0.02	0.00	0.00	18.67
Androcur 50mg tablets : 5
Low protein cakes☰	10	Foods for special diets	207	0.05	0.00	0.01	8.93
Taranis low protein lemon cake : 2 Taranis low protein pear cake : 3 Taranis low protein apricot cake : 5
Miconazole nitrate☰	11	Vaginal and vulval infections	33	0.33	0.01	0.04	8.87
Gyno-Daktarin 2% vaginal cream : 1 Miconazole 2% vaginal cream : 10
Hamamalis☰	7	Other anti-inflammatory preparations	105	0.07	0.00	0.01	8.37
Optrex Sore Eyes 13% eye drops : 7
Tolbutamide☰	25	Sulfonylureas	282	0.09	0.00	0.01	8.04
Tolbutamide 500mg tablets : 25

Prescribing where Balmoral Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gliclazide☰	123	Sulfonylureas	282	0.44	0.92	0.14	-3.60
Gliclazide 80mg tablets : 81 Gliclazide 40mg tablets : 17 Gliclazide 60mg modified-release tablets : 6 Gliclazide 30mg modified-release tablets : 19
Clotrimazole☰	20	Vaginal and vulval infections	33	0.61	0.90	0.10	-3.06
Clotrimazole 2% cream : 2 Canesten 2% thrush cream : 2 Clotrimazole 10% vaginal cream : 1 Fluconazole 150mg capsule and Clotrimazole 2% cream : 1 Clotrimazole 500mg pessaries : 3 Clotrimazole 200mg pessaries : 6 Clotrimazole 500mg pessary and Clotrimazole 2% cream : 5
Hydralazine hydrochloride☰	0	Vasodilator antihypertensive drugs	3	0.00	0.85	0.28	-3.01
Acamprosate calcium☰	0	Alcohol dependence	1	0.00	0.83	0.31	-2.70
Amlodipine☰	1369	Calcium-channel blockers	2908	0.47	0.75	0.11	-2.50
Amlodipine 5mg tablets : 892 Amlodipine 10mg tablets : 467 Amlodipine 10mg/5ml oral solution sugar free : 2 Amlodipine 5mg/5ml oral suspension sugar free : 1 Amlodipine 5mg/5ml oral solution sugar free : 4 Amlodipine 2.5mg tablets : 3