Static outliers for The Highlands 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 Highlands Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Soluble insulin (Neutral insulin)☰	33	Short-acting insulins	205	0.16	0.01	0.02	6.41
Humulin S 100units/ml solution for injection 3ml cartridges : 32 Humulin S 100units/ml solution for injection 10ml vials : 1
Flavoxate hydrochloride☰	20	Drugs for urinary frequency enuresis and incontinence	699	0.03	0.00	0.01	4.72
Flavoxate 200mg tablets : 20
Degarelix☰	35	Prostate cancer and gonadorelin analogues	106	0.33	0.03	0.07	4.26
Degarelix 80mg inj vials : 29 Firmagon 80mg inj vials : 2 Degarelix 120mg inj vials : 4
Ciclesonide☰	36	Corticosteroids (respiratory)	2060	0.02	0.00	0.00	3.69
Ciclesonide 160micrograms/dose inhaler CFC free : 9 Alvesco 80 inhaler : 4 Ciclesonide 80micrograms/dose inhaler CFC free : 7 Alvesco 160 inhaler : 16
Nepafenac☰	3	Ocular diagnostic & peri-operative prepn & photodynamic tt	3	1.00	0.14	0.27	3.20
Nevanac 1mg/ml eye drops : 3

Prescribing where The Highlands Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Levonorgestrel☰	0	Emergency contraception	1	0.00	0.62	0.33	-1.87
Mercaptopurine☰	6	Antimetabolites	38	0.16	0.80	0.35	-1.86
Mercaptopurine 50mg tablets : 6
Emollient bath and shower preparations☰	1	Emollient bath and shower preparations	4	0.25	0.61	0.21	-1.71
Dermol 600 bath emollient : 1
Losartan potassium☰	403	Angiotensin-II receptor antagonists	2212	0.18	0.50	0.19	-1.71
Losartan 25mg tablets : 76 Losartan 50mg tablets : 146 Losartan 100mg tablets : 170 Losartan 100mg/5ml oral liquid : 2 Losartan 12.5mg tablets : 9
Naftidrofuryl oxalate☰	0	Peripheral vasodilators and related drugs	2	0.00	0.66	0.39	-1.69