Static outliers for Goldsworth Park 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 Goldsworth Park Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Mianserin hydrochloride	8	Tricyclic and related antidepressant drugs	779	0.01	0.00	0.00	38.37
Mianserin 10mg tablets : 2 Mianserin 30mg tablets : 6
Piroxicam	136	Rubefacients, topical NSAIDS, capsaicin and poultice	225	0.60	0.05	0.09	6.08
Piroxicam 0.5% gel : 136
Metformin hydrochloride/sitagliptin	106	Other antidiabetic drugs	859	0.12	0.01	0.03	4.16
Metformin 1g / Sitagliptin 50mg tablets : 91 Janumet 50mg/1000mg tablets : 15
Influenza	950	Vaccines and antisera	974	0.98	0.08	0.22	4.06
Fluad vacc inj 0.5ml pre-filled syringes : 609 Flucelvax Tetra vacc inj 0.5ml pre-filled syringes : 341
Diltiazem hydrochloride	1	Soothing haemorrhoidal preparations	1	1.00	0.16	0.23	3.67
Diltiazem 2% ointment : 1

Prescribing where Goldsworth Park Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Zinc oxide	0	Soothing haemorrhoidal preparations	1	0.00	0.77	0.27	-2.89

Amoxicillin	217	Broad-spectrum penicillins	362	0.60	0.81	0.09	-2.46
Amoxicillin 500mg capsules : 143 Amoxicillin 250mg/5ml oral suspension sugar free : 63 Amoxicillin 125mg/5ml oral suspension sugar free : 2 Amoxicillin 3g oral powder sachets sugar free : 1 Amoxicillin 125mg/5ml oral suspension : 3 Amoxicillin 250mg capsules : 5
Solifenacin	29	Drugs for urinary frequency enuresis and incontinence	475	0.06	0.33	0.12	-2.30
Solifenacin 5mg tablets : 24 Solifenacin 10mg tablets : 5
Prucalopride	0	Other drugs used in constipation	5	0.00	0.71	0.33	-2.18

Codeine phosphate	0	Cough suppressants	1	0.00	0.76	0.35	-2.18