Static outliers for Mote

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 Mote is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Atenolol with calcium channel blocker 31 Beta-adrenoceptor blocking drugs 2901 0.01 0.00 0.00 11.30
Saxagliptin/metformin 25 Other antidiabetic drugs 1060 0.02 0.00 0.00 7.34
Hydrocortisone acetate 41 Otitis externa 124 0.33 0.03 0.04 6.89
Budesonide 877 Corticosteroids (respiratory) 1699 0.52 0.16 0.08 4.57
Telmisartan with diuretic 34 Angiotensin-II receptor antagonists 1739 0.02 0.00 0.00 4.57

Prescribing where Mote is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium permanganate 0 Oxidisers and dyes 1 0.00 0.94 0.22 -4.21
Gliclazide 350 Sulfonylureas 626 0.56 0.92 0.14 -2.70
Beclometasone dipropionate 493 Corticosteroids (respiratory) 1699 0.29 0.57 0.12 -2.35
Qvar 50 inhaler : 37
Qvar 100 inhaler : 72
Clenil Modulite 50micrograms/dose inhaler : 67
Clenil Modulite 100micrograms/dose inhaler : 140
Fostair 100micrograms/dose / 6micrograms/dose inhaler : 82
Fostair 200micrograms/dose / 6micrograms/dose inhaler : 47
Fostair NEXThaler 100microg/dose / 6microg/dose dry pdr inh : 2
Beclometasone 100mcg/dose breath actuated inhaler CFC free : 1
Beclometasone 100microg/Formoterol 6microg/dose inh CFCfree : 1
Easyhaler Beclometasone 200micrograms/dose dry pdr inhaler : 1
Clenil Modulite 200micrograms/dose inhaler : 14
Beclometasone 100micrograms/dose inhaler CFC free : 9
Beclometasone 200microg/Formoterol 6microg/dose inh CFC free : 3
Clenil Modulite 250micrograms/dose inhaler : 3
Fostair NEXThaler 200microg/dose / 6microg/dose dry pdr inh : 3
Beclometasone 50micrograms/dose inhaler CFC free : 6
Qvar 100 Autohaler : 5
Ibuprofen 45 Rubefacients, topical NSAIDS, capsaicin and poultice 381 0.12 0.52 0.20 -1.96
Medroxyprogesterone acetate 16 Parenteral progestogen-only contraceptives 28 0.57 0.88 0.16 -1.91