Static outliers for Buckland 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 Buckland Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Triamcinolone hexacetonide☰	53	Local corticosteroid injections	61	0.87	0.00	0.03	24.98
Triamcinolone hexacetonide 20mg/1ml inj ampoules : 53
Perindopril arginine☰	93	Angiotensin-converting enzyme inhibitors	2972	0.03	0.00	0.00	15.03
Coversyl Arginine 10mg tablets : 75 Coversyl Arginine 2.5mg tablets : 2 Coversyl Arginine 5mg tablets : 1 Perindopril arginine 5mg tablets : 4 Perindopril arginine 10mg tablets : 8 Perindopril arginine 2.5mg tablets : 3
Raltegravir☰	2	HIV infection	4	0.50	0.01	0.07	6.71
Raltegravir 600mg tablets : 2
Rosuvastatin calcium☰	1320	Lipid-regulating drugs	6992	0.19	0.04	0.02	6.36
Rosuvastatin 10mg tablets : 548 Rosuvastatin 20mg tablets : 77 Rosuvastatin 5mg tablets : 667 Crestor 5mg tablets : 1 Rosuvastatin 40mg tablets : 13 Crestor 10mg tablets : 8 Crestor 20mg tablets : 6
Mianserin hydrochloride☰	2	Tricyclic and related antidepressant drugs	1234	0.00	0.00	0.00	5.99
Mianserin 30mg tablets : 2

Prescribing where Buckland Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gliclazide☰	169	Sulfonylureas	492	0.34	0.92	0.14	-4.29
Gliclazide 80mg tablets : 63 Gliclazide 30mg modified-release tablets : 37 Diamicron 30mg MR tablets : 50 Gliclazide 40mg tablets : 14 Gliclazide 60mg modified-release tablets : 5
Quinine sulfate☰	76	Antimalarials	176	0.43	0.89	0.14	-3.26
Quinine sulfate 200mg tablets : 45 Quinine sulfate 300mg tablets : 31
Amlodipine☰	1591	Calcium-channel blockers	3254	0.49	0.75	0.11	-2.34
Amlodipine 5mg tablets : 1020 Amlodipine 10mg tablets : 553 Istin 5mg tablets : 3 Istin 10mg tablets : 3 Amlodipine 2.5mg tablets : 7 Amlodipine 5mg/5ml oral solution sugar free : 5
Tamsulosin hydrochloride☰	575	Drugs for urinary retention	736	0.78	0.92	0.06	-2.25
Tamsulosin 400microgram modified-release capsules : 479 Tamsulosin 400microgram modified-release tablets : 89 Faramsil 400microgram modified-release tablets (Sandoz) : 2 Flomaxtra XL 400microgram tablets : 1 Tabphyn MR 400microgram capsules (Genus Pharm) : 4
Hydralazine hydrochloride☰	4	Vasodilator antihypertensive drugs	13	0.31	0.85	0.28	-1.92
Hydralazine 25mg tablets : 4