Static outliers for Gillingham Medical 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 Gillingham Medical Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other osmotic laxative preparations 1 Osmotic laxatives 1020 0.00 0.00 0.00 16.89
Granisetron hydrochloride 2 Drugs used in nausea and vertigo 566 0.00 0.00 0.00 5.48
Undecenoates 7 Antifungal preparations 256 0.03 0.00 0.01 3.83
Salmeterol 94 Selective beta(2)-agonists 1782 0.05 0.01 0.01 3.75
Loperamide hydrochloride and simeticone 7 Antimotility drugs 213 0.03 0.00 0.01 3.55

Prescribing where Gillingham Medical Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Amoxicillin 206 Broad-spectrum penicillins 354 0.58 0.81 0.09 -2.66
Loperamide hydrochloride 206 Antimotility drugs 213 0.97 1.00 0.01 -2.60
Salbutamol 1471 Selective beta(2)-agonists 1782 0.83 0.91 0.05 -1.76
Salbutamol 100micrograms/dose inhaler CFC free : 1046
Salbutamol 100micrograms/dose breath actuated inh CFC free : 46
Ventolin 100micrograms/dose Evohaler : 236
Easyhaler Salbutamol sulfate 100micrograms/dose dry pdr inh : 30
Salbutamol 5mg/ml nebuliser liquid : 1
Salamol 5mg/2.5ml nebuliser liquid Steri-Neb unit dose vials : 1
Easyhaler Salbutamol sulfate 200micrograms/dose dry pdr inh : 1
Airomir 100micrograms/dose Autohaler : 28
Salamol 100micrograms/dose inhaler CFC free (Teva) : 13
Salbutamol 5mg/2.5ml nebuliser liquid unit dose vials : 8
Ventolin 200micrograms/dose Accuhaler : 12
Salbutamol 200micrograms/dose dry powder inhaler : 10
Salamol 100micrograms/dose Easi-Breathe inhaler : 10
Salbutamol 2mg tablets : 5
Airomir 100micrograms/dose inhaler : 5
Salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials : 19
Tacrolimus 0 Corticosteroids and other immunosuppressants 6 0.00 0.62 0.40 -1.56
Amiodarone hydrochloride 8 Drugs for arrhythmias 92 0.09 0.48 0.26 -1.53