Static outliers for Birchington 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 Birchington Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other osmotic laxative preparations☰	1	Osmotic laxatives	1060	0.00	0.00	0.00	16.25
Plenvu oral powder sachets : 1
Buspirone hydrochloride☰	219	Anxiolytics	658	0.33	0.03	0.06	4.72
Buspirone 5mg tablets : 133 Buspirone 10mg tablets : 86
Gluten free/wheat free grains/flours☰	3	Foods for special diets	109	0.03	0.00	0.01	4.71
Innovative Solutions Pure gluten free bakery blend mix : 3
Tafluprost and timolol☰	37	Treatment of glaucoma	1132	0.03	0.00	0.01	3.81
Taptiqom 15micrograms/ml / 5mg/ml eye drops 0.3ml unit dose : 36 Tafluprost 15microg/Timolol 5mg/ml eye dps 0.3ml : 1
Chlorpromazine hydrochloride☰	76	Antipsychotic drugs	727	0.10	0.02	0.03	2.87
Chlorpromazine 25mg tablets : 31 Chlorpromazine 50mg tablets : 36 Chlorpromazine 100mg tablets : 9

Prescribing where Birchington Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Diazepam☰	320	Anxiolytics	658	0.49	0.75	0.14	-1.97
Diazepam 2mg tablets : 179 Diazepam 5mg tablets : 123 Diazepam 10mg/2.5ml rectal solution tube : 1 Diazepam 10mg tablets : 17
Rifampicin☰	0	Antituberculosis drugs	3	0.00	0.73	0.40	-1.81
Amlodipine☰	2803	Calcium-channel blockers	5020	0.56	0.75	0.11	-1.73
Amlodipine 5mg tablets : 1801 Amlodipine 10mg tablets : 999 Amlodipine 2.5mg tablets : 3
Alendronic acid☰	555	Bisphosphonates and other drugs	758	0.73	0.87	0.09	-1.51
Alendronic acid 70mg tablets : 535 Alendronic acid 10mg tablets : 3 Alendronic acid 70mg effervescent tablets sugar free : 17
Furosemide☰	1069	Loop diuretics	1473	0.73	0.86	0.09	-1.46
Furosemide 20mg tablets : 562 Furosemide 40mg tablets : 507