Static outliers for Cross Deep 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 Cross Deep Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Arnica montana☰	2	Rubefacients, topical NSAIDS, capsaicin and poultice	147	0.01	0.00	0.00	33.51
Arnica montana gel : 2
Brivaracetam☰	51	Control of epilepsy	1163	0.04	0.00	0.00	11.06
Brivaracetam 75mg tablets : 3 Brivaracetam 25mg tablets : 24 Brivaracetam 100mg tablets : 24
Agomelatine☰	31	Other antidepressant drugs	724	0.04	0.00	0.00	9.44
Agomelatine 25mg tablets : 31
Hyoscine☰	26	Drugs used in nausea and vertigo	178	0.15	0.02	0.02	5.14
Scopoderm 1.5mg patches : 7 Hyoscine 1mg/72hours transdermal patches : 19
Zuclopenthixol hydrochloride☰	44	Antipsychotic drugs	754	0.06	0.01	0.01	3.68
Clopixol 10mg tablets : 20 Zuclopenthixol 10mg tablets : 24

Prescribing where Cross Deep Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Spironolactone☰	106	Potassium-sparing diuretics and aldosterone antagonists	309	0.34	0.72	0.14	-2.74
Spironolactone 25mg tablets : 81 Spironolactone 12.5mg tablets : 3 Spironolactone 100mg tablets : 7 Spironolactone 50mg tablets : 15
Gabapentin☰	59	Control of epilepsy	1163	0.05	0.24	0.08	-2.31
Gabapentin 300mg capsules : 46 Gabapentin 600mg tablets : 3 Gabapentin 100mg capsules : 10
Calcium carbonate☰	18	Calcium supplements	27	0.67	0.95	0.13	-2.13
Calcichew 500mg chewable tablets : 2 Adcal 1500mg chewable tablets : 2 Calcichew Forte chewable tablets : 4 Calcium carbonate 1.5g chewable tablets sugar free : 10
Co-amilofruse (Amiloride hydrochloride/frusemide)☰	0	Potassium sparing diuretics and compounds	5	0.00	0.68	0.33	-2.07
Glucose☰	2	Treatment of hypoglycaemia	6	0.33	0.75	0.21	-2.02
GlucoGel 40% gel original : 2