Static outliers for Fordbridge Medical 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 Fordbridge Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Clonazepam☰	1	Drugs used in status epilepticus	2	0.50	0.00	0.01	66.77
Clonazepam 1mg/1ml inj ampoules and diluent : 1
Low protein cakes☰	9	Foods for special diets	132	0.07	0.00	0.01	12.68
Taranis low protein lemon cake : 3 Taranis low protein apricot cake : 3 Taranis low protein pear cake : 3
Dextromethorphan hydrobromide☰	5	Cough suppressants	7	0.71	0.01	0.06	11.32
Delsym 12 Hour Cough Relief liquid : 1 Dextromethorphan 30mg/5ml oral suspension : 4
Aceclofenac☰	7	Non-steroidal anti-inflammatory drugs	330	0.02	0.00	0.00	8.66
Aceclofenac 100mg tablets : 7
Imidapril hydrochloride☰	8	Angiotensin-converting enzyme inhibitors	1410	0.01	0.00	0.00	7.30
Imidapril 10mg tablets : 3 Imidapril 20mg tablets : 5

Prescribing where Fordbridge Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	10	Skeletal muscle relaxants	29	0.34	0.83	0.18	-2.62
Baclofen 10mg tablets : 10
Apixaban☰	55	Oral anticoagulants	612	0.09	0.40	0.14	-2.18
Apixaban 5mg tablets : 38 Apixaban 2.5mg tablets : 17
Ganciclovir☰	0	Antivirals	1	0.00	0.68	0.42	-1.60
Chloramphenicol☰	32	Antibacterials	55	0.58	0.78	0.13	-1.53
Minims chloramphenicol 0.5% eye drops 0.5ml unit dose : 1 Chloramphenicol 1% eye ointment : 9 Chloramphenicol 0.5% eye drops : 22
Pneumococcal☰	0	Vaccines and antisera	6	0.00	0.50	0.34	-1.47