Static outliers for Mid Sussex Health Care

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 Mid Sussex Health Care is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Xipamide 12 Thiazides and related diuretics 1404 0.01 0.00 0.00 6.63
Low protein pasta 12 Foods for special diets 117 0.10 0.00 0.02 5.10
Low protein biscuits 9 Foods for special diets 117 0.08 0.00 0.02 4.47
Fluticasone propionate (Inhalation) 1224 Corticosteroids (respiratory) 2388 0.51 0.18 0.08 4.12
Seretide 100 Accuhaler : 49
Seretide 250 Accuhaler : 70
Seretide 500 Accuhaler : 158
Seretide 50 Evohaler : 95
Seretide 125 Evohaler : 184
Seretide 250 Evohaler : 226
Flutiform 125micrograms/dose / 5micrograms/dose inhaler : 85
Flutiform 250micrograms/dose / 10micrograms/dose inhaler : 45
Flutiform 50micrograms/dose / 5micrograms/dose inhaler : 30
Sirdupla 25micrograms/dose / 125micrograms/dose inhaler : 99
Sirdupla 25micrograms/dose / 250micrograms/dose inhaler : 102
Sereflo 25micrograms/dose / 250micrograms/dose inhaler : 2
Fluticasone 125micrograms/dose inhaler CFC free : 1
Fluticasone 250micrograms/dose inhaler CFC free : 1
Flixotide 50micrograms/dose Accuhaler : 1
AirFluSal Forspiro 50microg / 500microg/dose dry pdr inh : 1
Fluticasone propion 500mcg/Salmeterol 50mcg/dose dry pdr inh : 4
Sereflo 25micrograms/dose / 125micrograms/dose inhaler : 4
Flixotide 100micrograms/dose Accuhaler : 8
Flixotide 500micrograms/dose Accuhaler : 3
Flixotide 250micrograms/dose Evohaler : 3
Flixotide 125micrograms/dose Evohaler : 12
Flixotide 50micrograms/dose Evohaler : 16
Fluticasone 50micrograms/dose inhaler CFC free : 15
Fluticasone 250mcg/dose / Salmeterol 25mcg/dose inh CFC free : 5
Fluticasone 125microg / Formoterol 5microg/dose inh CFC free : 5
Bambuterol hydrochloride 5 Selective beta(2)-agonists 1985 0.00 0.00 0.00 3.59

Prescribing where Mid Sussex Health Care is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amoxicillin 270 Broad-spectrum penicillins 442 0.61 0.81 0.09 -2.33
Beclometasone dipropionate 757 Corticosteroids (respiratory) 2388 0.32 0.57 0.12 -2.13
Furosemide 886 Loop diuretics 1263 0.70 0.86 0.09 -1.73
Salicylic acid 4 Preparations for warts and calluses 19 0.21 0.69 0.31 -1.53
Ticagrelor 4 Antiplatelet drugs 3101 0.00 0.02 0.01 -1.36