Static outliers for Dapdune House Surgery

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 Dapdune House Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Vortioxetine	275	Other antidepressant drugs	1405	0.20	0.01	0.02	10.42
Vortioxetine 5mg tablets : 105 Vortioxetine 10mg tablets : 115 Vortioxetine 20mg tablets : 55
Dibrompropamidine isetionate	1	Preparations for minor cuts and abrasions	1	1.00	0.01	0.10	9.47
Dibrompropamidine 0.15% cream : 1
Ibuprofen lysine	5	Non-steroidal anti-inflammatory drugs	626	0.01	0.00	0.00	7.51
Ibuprofen lysine 400mg tablets : 5
Nadolol	12	Beta-adrenoceptor blocking drugs	1657	0.01	0.00	0.00	7.11
Nadolol 80mg tablets : 12
Hamamelis	3	Soothing haemorrhoidal preparations	14	0.21	0.00	0.03	6.20
Preparation H 50% clear gel : 3

Prescribing where Dapdune House Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Medroxyprogesterone acetate	11	Parenteral progestogen-only contraceptives	31	0.35	0.88	0.16	-3.24
Medroxyprogesterone 104mg/0.65ml inj pf disposable devices : 1 Sayana Press 104mg/0.65ml inj pre-filled disposable devices : 1 Medroxyprogesterone 150mg/1ml inj pre-filled syringes : 3 Depo-Provera 150mg/1ml inj pre-filled syringes : 6
Alendronic acid	227	Bisphosphonates and other drugs	392	0.58	0.87	0.09	-3.17
Alendronic acid 70mg tablets : 227
Solifenacin	35	Drugs for urinary frequency enuresis and incontinence	260	0.13	0.33	0.12	-1.67
Solifenacin 5mg tablets : 30 Solifenacin 10mg tablets : 5
Lidocaine hydrochloride	32	Local anaesthetics	47	0.68	0.91	0.14	-1.62
Lidocaine 2.5% / Prilocaine 2.5% cream : 2 Instillagel gel : 1 Emla 5% cream : 8 Lidocaine 5% medicated plasters : 11 Lidocaine 20mg/2ml (1%) solution for injection ampoules : 10
Menthol	0	Topical local anaesthetics and antipruritics	5	0.00	0.46	0.30	-1.52