Static outliers for Woodlands Health 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 Woodlands Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Stiripentol☰	12	Control of epilepsy	951	0.01	0.00	0.00	20.71
Stiripentol 250mg oral powder sachets : 6 Stiripentol 500mg oral powder sachets : 6
Asenapine☰	2	Drugs used for mania and hypomania	41	0.05	0.00	0.00	10.16
Asenapine 10mg sublingual tablets sugar free : 2
Labetalol hydrochloride☰	41	Beta-adrenoceptor blocking drugs	911	0.05	0.00	0.00	9.32
Labetalol 400mg tablets : 9 Labetalol 200mg tablets : 7 Labetalol 100mg tablets : 25
Selegiline hydrochloride☰	5	Dopaminergic drugs used in parkinsonism	42	0.12	0.00	0.01	7.90
Selegiline 5mg tablets : 5
Metformin hydrochloride/sitagliptin☰	198	Other antidiabetic drugs	994	0.20	0.01	0.03	6.95
Metformin 1g / Sitagliptin 50mg tablets : 198

Prescribing where Woodlands Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Isosorbide mononitrate☰	53	Nitrates	154	0.34	0.73	0.11	-3.62
Isosorbide mononitrate 25mg modified-release capsules : 9 Isosorbide mononitrate 50mg modified-release capsules : 4 Isosorbide mononitrate 10mg tablets : 25 Isosorbide mononitrate 60mg modified-release tablets : 10 Isosorbide mononitrate 20mg tablets : 5
Theophylline☰	0	Theophylline	2	0.00	0.83	0.25	-3.38
Allopurinol☰	109	Gout and cytotoxic induced hyperiuicaemia	150	0.73	0.89	0.05	-3.15
Allopurinol 100mg tablets : 71 Allopurinol 300mg tablets : 38
Tramadol hydrochloride☰	7	Opioid analgesics	429	0.02	0.27	0.09	-2.77
Tramadol 100mg modified-release tablets : 1 Tramadol 50mg modified-release tablets : 1 Tramadol 50mg capsules : 5
Mebeverine hydrochloride☰	12	Antispasmodic and other drugs altering gut motility	89	0.13	0.45	0.13	-2.48
Mebeverine 135mg tablets : 6 Mebeverine 200mg modified-release capsules : 6