Static outliers for Dr Rs Durston'S 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 Dr Rs Durston'S Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Other topical corticosteroid preparations	3	Topical corticosteroids	527	0.01	0.0	0.00	15.51
Propylene glycol 40% in Clobetasol 0.05% cream : 3
Dibrompropamidine isetionate	1	Antibacterials	62	0.02	0.0	0.00	10.92
Dibrompropamidine 0.15% eye ointment : 1
Mefloquine hydrochloride	1	Antimalarials	124	0.01	0.0	0.00	6.29
Mefloquine 250mg tablets : 1
Cefixime	1	Cephalosporins	19	0.05	0.0	0.01	5.24
Cefixime 200mg tablets : 1
Eletriptan	4	Treatment of acute migraine	75	0.05	0.0	0.01	3.37
Eletriptan 40mg tablets : 1 Eletriptan 20mg tablets : 3

Prescribing where Dr Rs Durston'S Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Pizotifen malate	0	Prophylaxis of migraine	29	0.00	0.65	0.26	-2.49

Co-cyprindiol (Cyprote acetate/ethinylestradiol)	2	Oral preparations for acne	3	0.67	0.97	0.13	-2.27
Co-cyprindiol 2000microgram/35microgram tablets : 2
Quinine sulfate	73	Antimalarials	124	0.59	0.89	0.14	-2.15
Quinine sulfate 200mg tablets : 37 Quinine sulfate 300mg tablets : 36
Pregabalin	206	Control of epilepsy	1657	0.12	0.27	0.08	-1.83
Pregabalin 25mg capsules : 45 Pregabalin 50mg capsules : 56 Pregabalin 75mg capsules : 31 Pregabalin 100mg capsules : 27 Pregabalin 300mg capsules : 26 Pregabalin 150mg capsules : 16 Pregabalin 200mg capsules : 5
Flecainide acetate	0	Drugs for arrhythmias	6	0.00	0.46	0.25	-1.81