Static outliers for The Bosmere 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 The Bosmere Medical Practice is higher than most
| BNF Chemical | Chemical Items | BNF Subparagraph | Subparagraph Items | Ratio | Mean | std | Z_Score | Plots |
|---|---|---|---|---|---|---|---|---|
| Tolcapone | 7 | Dopaminergic drugs used in parkinsonism | 340 | 0.02 | 0.00 | 0.00 | 34.43 |  |
| Levothyroxine sodium and liothyronine | 6 | Thyroid hormones | 2562 | 0.00 | 0.00 | 0.00 | 5.49 |  |
| Tiagabine | 6 | Control of epilepsy | 3683 | 0.00 | 0.00 | 0.00 | 4.62 |  |
| Betaine anhydrous | 10 | Drugs used in metabolic disorders | 10 | 1.00 | 0.05 | 0.22 | 4.36 |  |
| Magnesium hydroxide | 2 | Osmotic laxatives | 1072 | 0.00 | 0.00 | 0.00 | 3.98 |  |
Prescribing where The Bosmere Medical Practice is lower than most
| BNF Chemical | Chemical Items | BNF Subparagraph | Subparagraph Items | Ratio | Mean | std | Z_Score | Plots |
|---|---|---|---|---|---|---|---|---|
| Other emollient preparations | 198 | Emollients | 293 | 0.68 | 0.89 | 0.07 | -3.05 |  |
Aveeno cream : 32 Dermol 500 lotion : 90 Doublebase Dayleve gel : 2 White soft paraffin 95% / Liquid paraffin 5% ointment : 1 Ultrabase cream : 1 Oilatum Junior cream : 1 Eucerin UreaRepair Plus 10% urea lotion : 1 Aveeno Intense Relief hand cream : 4 Aveeno Skin Relief moisturising lotion with shea butter : 8 Diprobase ointment : 3 White soft paraffin 50% / Liquid paraffin 50% ointment : 7 Isopropyl myristate 15% / Liquid paraffin 15% gel : 7 Doublebase gel : 7 Aveeno lotion : 7 Dermol cream : 7 E45 cream : 20 | ||||||||
| Hydralazine hydrochloride | 0 | Vasodilator antihypertensive drugs | 1 | 0.00 | 0.85 | 0.28 | -3.01 |  |
| Levothyroxine sodium | 2538 | Thyroid hormones | 2562 | 0.99 | 1.00 | 0.00 | -2.67 |  |
| Mercaptopurine | 3 | Antimetabolites | 29 | 0.10 | 0.80 | 0.35 | -2.01 |  |
| Losartan potassium | 259 | Angiotensin-II receptor antagonists | 1870 | 0.14 | 0.50 | 0.19 | -1.94 |  |