Static outliers for Dr S Morcos

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 Dr S Morcos is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Paracetamol combined preparations	24	Non-opioid analgesics and compound preparations	876	0.03	0.00	0.00	38.25
Solpadeine Max soluble tablets : 24
Betaxolol	14	Treatment of glaucoma	234	0.06	0.00	0.00	13.20
Betaxolol 0.5% eye drops : 8 Betoptic 0.5% eye drops : 3 Betoptic 0.25% suspension eye drops : 3
Imidapril hydrochloride	6	Angiotensin-converting enzyme inhibitors	771	0.01	0.00	0.00	10.07
Imidapril 5mg tablets : 3 Imidapril 20mg tablets : 3
Ciprofloxacin	60	Antibacterials	92	0.65	0.06	0.07	8.18
Ciprofloxacin 0.3% eye drops : 60
Miconazole nitrate	10	Vaginal and vulval infections	35	0.29	0.01	0.04	7.54
Miconazole 2% vaginal cream : 2 Gyno-Daktarin 2% vaginal cream : 8

Prescribing where Dr S Morcos is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Fluconazole	1	Triazole antifungals	5	0.20	0.85	0.15	-4.45
Fluconazole 50mg capsules : 1
Chloramphenicol	26	Antibacterials	92	0.28	0.78	0.13	-3.84
Chloramphenicol 1% eye ointment : 16 Chloramphenicol 0.5% eye drops : 10
Medroxyprogesterone acetate	6	Parenteral progestogen-only contraceptives	19	0.32	0.88	0.16	-3.48
Medroxyprogesterone 150mg/1ml inj pre-filled syringes : 1 Depo-Provera 150mg/1ml inj pre-filled syringes : 5
Azathioprine	11	Antiproliferative immunosuppressants	51	0.22	0.80	0.19	-3.17
Azathioprine 50mg tablets : 11
Cabergoline	0	Bromocriptine and other dopaminergic drugs	2	0.00	0.86	0.27	-3.16