Static outliers for The Mill 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 The Mill Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Cetylpyridinium chloride	1	Mouth-washes, gargles and dentifrices	6	0.17	0.00	0.03	5.91
Anbesol liquid : 1
Gluten free/low protein mixes	7	Foods for special diets	241	0.03	0.00	0.01	4.84
Mevalia low protein burger mix : 1 PK Foods low protein jelly mix dessert (2 flavours) : 1 Mevalia low protein bread mix : 5
Cefradine	28	Cephalosporins	78	0.36	0.02	0.08	4.43
Cefradine 500mg capsules : 7 Cefradine 250mg capsules : 21
Low protein grains/flours	5	Foods for special diets	241	0.02	0.00	0.00	4.36
Loprofin low protein rice : 5
Gluten free/low protein biscuits	10	Foods for special diets	241	0.04	0.00	0.01	3.54
Mevalia low protein frollini biscuits : 5 Mevalia low protein cookies : 5

Prescribing where The Mill Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Cefalexin	50	Cephalosporins	78	0.64	0.96	0.10	-3.11
Cefalexin 500mg capsules : 29 Cefalexin 250mg/5ml oral suspension : 1 Cefalexin 125mg/5ml oral suspension : 4 Cefalexin 250mg capsules : 8 Cefalexin 250mg tablets : 8
Alendronic acid	445	Bisphosphonates and other drugs	683	0.65	0.87	0.09	-2.39
Alendronic acid 70mg tablets : 443 Alendronic acid 70mg/100ml soln unit dose sugar free : 2
Gabapentin	225	Control of epilepsy	3465	0.06	0.24	0.08	-2.14
Gabapentin 100mg capsules : 53 Gabapentin 300mg capsules : 119 Gabapentin 600mg tablets : 40 Gabapentin 400mg capsules : 13
Somatropin	1	Hypothalamic & anterior pituitary hormone & antioestrogens	3	0.33	0.90	0.27	-2.09
Zomacton 10mg inj vials : 1
Apixaban	264	Oral anticoagulants	2033	0.13	0.40	0.14	-1.90
Apixaban 2.5mg tablets : 103 Apixaban 5mg tablets : 158 Eliquis 5mg tablets : 3