Static outliers for Triveni Pms

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 Triveni Pms is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Tiagabine☰	19	Control of epilepsy	1244	0.02	0.00	0.00	44.11
Tiagabine 5mg tablets : 19
Lisinopril with diuretic☰	218	Angiotensin-converting enzyme inhibitors	2159	0.10	0.00	0.01	16.55
Lisinopril 20mg / Hydrochlorothiazide 12.5mg tablets : 120 Lisinopril 10mg / Hydrochlorothiazide 12.5mg tablets : 98
Tetracaine☰	22	Local anaesthetics	37	0.59	0.02	0.06	8.89
Ametop 4% gel : 22
Irbesartan with diuretic☰	38	Angiotensin-II receptor antagonists	648	0.06	0.00	0.01	7.28
Irbesartan 150mg / Hydrochlorothiazide 12.5mg tablets : 18 Irbesartan 300mg / Hydrochlorothiazide 25mg tablets : 3 Irbesartan 300mg / Hydrochlorothiazide 12.5mg tablets : 17
Chloramphenicol☰	1	Otitis externa	41	0.02	0.00	0.00	6.31
Chloramphenicol 5% ear drops : 1

Prescribing where Triveni Pms is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Lidocaine hydrochloride☰	13	Local anaesthetics	37	0.35	0.91	0.14	-4.00
Bonjela Junior gel : 2 Emla 5% cream : 4 Lidocaine 5% medicated plasters : 7
Tiotropium bromide☰	48	Antimuscarinic bronchodilators	355	0.14	0.71	0.18	-3.15
Spiriva Respimat 2.5microg/dose inhalation soln : 46 Tiotropium bromide 18microgram inhalation powder capsules : 1 Spiriva 18microgram inhalation pdr caps with HandiHaler : 1
Other multivitamin preparations☰	11	Multivitamin preparations	44	0.25	0.81	0.21	-2.69
Forceval capsules : 3 Valupak Multivitamin One A Day tablets : 3 Multivitamin tablets : 5
Quinine sulfate☰	41	Antimalarials	79	0.52	0.89	0.14	-2.64
Quinine sulfate 200mg tablets : 39 Quinine sulfate 300mg tablets : 2
Fluconazole☰	6	Triazole antifungals	12	0.50	0.85	0.15	-2.39
Fluconazole 50mg capsules : 2 Fluconazole 150mg capsules : 4