Static outliers for Moat 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 Moat House Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Aceclofenac☰	24	Non-steroidal anti-inflammatory drugs	850	0.03	0.00	0.00	11.58
Preservex 100mg tablets : 24
Dithranol☰	6	Preparations for psoriasis	68	0.09	0.00	0.01	8.22
Dithrocream 0.1% cream : 6
Perampanel☰	48	Control of epilepsy	2779	0.02	0.00	0.00	4.19
Perampanel 2mg tablets : 24 Perampanel 4mg tablets : 24
Cefradine☰	30	Cephalosporins	105	0.29	0.02	0.08	3.46
Cefradine 250mg capsules : 30
Tapentadol hydrochloride☰	104	Opioid analgesics	1506	0.07	0.01	0.02	3.46
Tapentadol 50mg tablets : 33 Tapentadol 200mg modified-release tablets : 21 Tapentadol 50mg modified-release tablets : 20 Tapentadol 100mg modified-release tablets : 15 Tapentadol 150mg modified-release tablets : 15

Prescribing where Moat House Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cefalexin☰	74	Cephalosporins	105	0.70	0.96	0.10	-2.49
Cefalexin 250mg capsules : 45 Cefalexin 500mg tablets : 2 Cefalexin 250mg tablets : 4 Cefalexin 500mg capsules : 17 Cefalexin 125mg/5ml oral suspension : 6
Baclofen☰	73	Skeletal muscle relaxants	194	0.38	0.83	0.18	-2.44
Baclofen 10mg tablets : 60 Baclofen 5mg/5ml oral solution sugar free : 13
Vitamin E☰	0	Vitamin E	1	0.00	0.73	0.41	-1.78
Gabapentin☰	276	Control of epilepsy	2779	0.10	0.24	0.08	-1.71
Gabapentin 100mg capsules : 29 Gabapentin 300mg capsules : 155 Gabapentin 600mg tablets : 81 Gabapentin 400mg capsules : 11
Solifenacin☰	64	Drugs for urinary frequency enuresis and incontinence	456	0.14	0.33	0.12	-1.63
Solifenacin 10mg tablets : 36 Vesicare 5mg tablets : 8 Solifenacin 5mg tablets : 20