Static outliers for Red Lion Road 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 Red Lion Road Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Torasemide☰	24	Loop diuretics	334	0.07	0.00	0.00	14.81
Torasemide 5mg tablets : 24
Emulsifying wax☰	8	Emollients	38	0.21	0.01	0.03	6.84
Emulsifying ointment : 8
Levodopa/carbidopa/entacapone☰	2	Dopaminergic drugs used in parkinsonism	6	0.33	0.03	0.05	6.68
Levodopa 100mg / Carbidopa 25mg / Entacapone 200mg tablets : 2
Sodium valproate☰	119	Control of epilepsy	378	0.31	0.08	0.04	6.20
Sodium valproate 500mg modified-release tablets : 53 Sodium valproate 200mg/5ml oral solution : 1 Sodium valproate 200mg gastro-resistant tablets : 13 Sodium valproate 500mg gastro-resistant tablets : 27 Sodium valproate 300mg modified-release tablets : 8 Epilim 200mg/5ml liquid : 3 Epilim Chrono 500 tablets : 3 Epilim 500 gastro-resistant tablets : 6 Epilim Chrono 300 tablets : 5
Captopril☰	13	Angiotensin-converting enzyme inhibitors	805	0.02	0.00	0.00	6.00
Captopril 25mg tablets : 2 Captopril 12.5mg tablets : 8 Captopril 50mg tablets : 3

Prescribing where Red Lion Road Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other emollient preparations☰	20	Emollients	38	0.53	0.89	0.07	-5.19
Aveeno cream : 2 Dermol cream : 2 Oilatum cream : 1 Doublebase gel : 4 Dermol 500 lotion : 8 Diprobase ointment : 3
Desogestrel☰	6	Oral progestogen-only contraceptives	9	0.67	0.94	0.05	-5.00
Cerelle 75microgram tablets : 2 Desogestrel 75microgram tablets : 4
Spironolactone☰	13	Potassium-sparing diuretics and aldosterone antagonists	69	0.19	0.72	0.14	-3.87
Spironolactone 50mg tablets : 4 Spironolactone 100mg tablets : 3 Spironolactone 25mg tablets : 6
Other multivitamin preparations☰	12	Multivitamin preparations	52	0.23	0.81	0.21	-2.78
Dalivit oral drops : 2 Valupak Multivitamin One A Day tablets : 1 Abidec Multivitamin drops : 3 Renavit tablets : 6
Benzoyl peroxide and clindamycin phosphate☰	0	Topical preparations for acne	6	0.00	0.38	0.14	-2.73