Static outliers for Faccini House 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 Faccini House Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gluten free/low protein cereals☰	4	Foods for special diets	45	0.09	0.00	0.01	16.82
Promin low protein hot breakfast powder 57g sach chocolate : 2 Promin low protein hot breakfast powder 57g sach : 1 Promin low protein hot breakfast powder 57g sachets banana : 1
Betamethasone sodium phosphate☰	37	Otitis externa	52	0.71	0.03	0.06	11.59
Betamethasone 0.1% / Neomycin 0.5% ear/eye/nose drops : 37
Low protein miscellaneous☰	1	Foods for special diets	45	0.02	0.00	0.00	11.26
Taranis low protein hazelnut spread : 1
Iron and folic acid☰	34	Oral iron	500	0.07	0.00	0.01	10.85
Ferrograd Folic 325mg/350microgram modified-release tablets : 32 Pregaday 322mg/350microgram tablets : 2
Low protein mixes☰	12	Foods for special diets	45	0.27	0.01	0.02	10.43
Fate low protein plain cake mix : 1 Fate low protein chocolate cake mix : 1 Loprofin low protein cake mix : 1 Promin low protein sausage mix 30g sachets apple & sage : 1 Promin low protein sausage mix 30g sachets tomato & basil : 1 Fate low protein all purpose mix : 4 Loprofin low protein mix : 3

Prescribing where Faccini House Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Dexamethasone☰	14	Otitis externa	52	0.27	0.78	0.13	-3.88
Otomize ear spray : 14
Clotrimazole☰	8	Vaginal and vulval infections	15	0.53	0.90	0.10	-3.81
Clotrimazole 2% cream : 1 Clotrimazole 500mg pessary and Clotrimazole 2% cream : 4 Clotrimazole 200mg pessaries : 3
Zinc oxide☰	0	Soothing haemorrhoidal preparations	1	0.00	0.77	0.27	-2.89
Hydrocortisone☰	0	Copound haemorrhoidal preparations with corticosteroid	38	0.00	0.58	0.24	-2.41
Codeine phosphate☰	0	Cough suppressants	2	0.00	0.76	0.35	-2.18