Static outliers for Riverside Medical Practice

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 Riverside Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Phased formulations of ethinylestradiol	46	Combined hormonal contraceptives	296	0.16	0.01	0.02	9.00
Logynon tablets : 45 TriRegol tablets : 1
Doxylamine succinate/pyridoxine hydrochloride	8	Drugs used in nausea and vertigo	196	0.04	0.00	0.01	7.49
Doxylamine 10mg / Pyridoxine 10mg gastro-resistant tablets : 4 Xonvea 10mg/10mg gastro-resistant tablets : 4
Compound alginates and proprietary indigestion preparations	5	Compound Alginates and proprietary indigestion preparations	175	0.03	0.00	0.00	5.50
Rennie Deflatine chewable tablets : 5
Glutaraldehyde	4	Preparations for warts and calluses	13	0.31	0.01	0.07	4.49
Glutarol 10% cutaneous solution : 1 Glutaraldehyde 10% solution : 3
Trihexyphenidyl hydrochloride	15	Antimuscarinic drugs used in parkinsonism	15	1.00	0.15	0.21	4.14
Trihexyphenidyl 2mg tablets : 15

Prescribing where Riverside Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Procyclidine hydrochloride	0	Antimuscarinic drugs used in parkinsonism	15	0.00	0.84	0.21	-4.04

Aciclovir	60	Herpes simplex and varicella-zoster	76	0.79	0.95	0.07	-2.39
Aciclovir 800mg tablets : 14 Aciclovir 400mg tablets : 28 Aciclovir 200mg/5ml oral suspension sugar free : 3 Aciclovir 200mg tablets : 15
Ramipril	965	Angiotensin-converting enzyme inhibitors	2917	0.33	0.69	0.17	-2.16
Ramipril 1.25mg capsules : 122 Ramipril 2.5mg capsules : 287 Ramipril 5mg capsules : 250 Ramipril 10mg capsules : 232 Ramipril 2.5mg tablets : 39 Ramipril 1.25mg tablets : 13 Ramipril 10mg tablets : 12 Ramipril 5mg tablets : 10
Doxycycline hyclate	67	Tetracyclines	192	0.35	0.63	0.14	-2.09
Doxycycline 100mg capsules : 59 Doxycycline 100mg dispersible tablets sugar free : 1 Doxycycline 50mg capsules : 7
Methylprednisolone acetate	0	Local corticosteroid injections	18	0.00	0.73	0.39	-1.87