Static outliers for Battersea Rise Group 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 Battersea Rise Group Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Hamamelis	2	Soothing haemorrhoidal preparations	4	0.50	0.00	0.03	14.61
Preparation H 50% clear gel : 2
Brivaracetam	34	Control of epilepsy	669	0.05	0.00	0.00	12.89
Brivaracetam 50mg tablets : 34
Pentosan polysulfate sodium	3	Oral anticoagulants	753	0.00	0.00	0.00	10.03
Pentosan polysulfate sodium 100mg capsules : 3
Cefradine	28	Cephalosporins	42	0.67	0.02	0.08	8.49
Cefradine 250mg capsules : 28
Hyoscine hydrobromide	43	Drugs used in nausea and vertigo	146	0.29	0.02	0.03	8.23
Hyoscine hydrobromide 150microgram tablets : 42 Hyoscine hydrobromide 300microgram tablets : 1

Prescribing where Battersea Rise Group Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Cefalexin	13	Cephalosporins	42	0.31	0.96	0.10	-6.36
Cefalexin 125mg/5ml oral suspension : 1 Cefalexin 500mg tablets : 4 Cefalexin 250mg tablets : 3 Cefalexin 500mg capsules : 5
Tamsulosin hydrochloride	200	Drugs for urinary retention	287	0.70	0.92	0.06	-3.65
Tamsulosin 400microgram modified-release capsules : 200
Mebeverine hydrochloride	2	Antispasmodic and other drugs altering gut motility	22	0.09	0.45	0.13	-2.82
Mebeverine 135mg tablets : 1 Mebeverine 200mg modified-release capsules : 1
Acamprosate calcium	0	Alcohol dependence	3	0.00	0.83	0.31	-2.70

Glycopyrronium bromide	0	Antimuscarinic drugs	1	0.00	0.82	0.36	-2.30