Static outliers for Fountain Practice

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 Fountain Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Lithium citrate☰	7	Drugs used for mania and hypomania	22	0.32	0.01	0.03	12.18
Priadel 520mg/5ml liquid : 7
Orphenadrine hydrochloride☰	7	Antimuscarinic drugs used in parkinsonism	25	0.28	0.01	0.03	7.92
Orphenadrine 50mg/5ml oral solution sugar free : 7
Alprostadil☰	25	Drugs for erectile dysfunction	184	0.14	0.02	0.02	4.61
Caverject 20microgram inj vials : 2 Alprostadil 3mg/g cream : 3 Caverject Dual Chamber 20microgram inj : 10 Alprostadil 20microgram inj pre-filled disposable devices : 5 Vitaros 3mg/g cream : 5
Propafenone hydrochloride☰	11	Drugs for arrhythmias	46	0.24	0.02	0.05	4.09
Propafenone 150mg tablets : 11
Citalopram hydrochloride☰	19	Selective serotonin re-uptake inhibitors	1800	0.01	0.00	0.00	4.02
Citalopram 40mg/ml oral drops sugar free : 19

Prescribing where Fountain Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sulfasalazine☰	6	Aminosalicylates	133	0.05	0.33	0.14	-2.01
Sulfasalazine 500mg tablets : 1 Sulfasalazine 500mg gastro-resistant tablets : 5
Ispaghula husk☰	22	Bulk-forming laxatives	27	0.81	0.96	0.07	-1.99
Fybogel Lemon 3.5g effervescent granules sachets SF : 2 Fybogel Orange 3.5g effervescent granules sachets SF : 9 Ispaghula husk 3.5g efferv gran sach gluten free sugar free : 11
Aciclovir☰	32	Herpes simplex and varicella-zoster	39	0.82	0.95	0.07	-1.94
Aciclovir 400mg tablets : 13 Aciclovir 800mg tablets : 12 Aciclovir 200mg tablets : 7
Solifenacin☰	35	Drugs for urinary frequency enuresis and incontinence	291	0.12	0.33	0.12	-1.80
Solifenacin 5mg tablets : 13 Solifenacin 10mg tablets : 12 Solifenacin 1mg/ml oral suspension sugar free : 5 Vesicare 5mg tablets : 5
Ibuprofen☰	51	Rubefacients, topical NSAIDS, capsaicin and poultice	297	0.17	0.52	0.20	-1.70
Ibuprofen 5% gel : 32 Ibuleve Maximum Strength 10% gel : 2 Ibuprofen 5% spray : 1 Fenbid Forte 10% gel : 1 Ibuprofen 10% gel : 15