Static outliers for Hill Lane 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 Hill Lane Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Zuclopenthixol acetate☰	2	Antipsychotic drugs	832	0.00	0.00	0.00	62.58
Clopixol Acuphase 50mg/1ml solution for injection ampoules : 2
Dronabinol/cannabidiol☰	4	Skeletal muscle relaxants	35	0.11	0.00	0.01	12.99
Sativex oromucosal spray : 4
Denosumab☰	45	Bisphosphonates and other drugs	222	0.20	0.01	0.02	10.27
Denosumab 60mg/1ml inj pre-filled syringes : 45
Agomelatine☰	30	Other antidepressant drugs	1032	0.03	0.00	0.00	6.31
Agomelatine 25mg tablets : 30
Isosorbide dinitrate☰	16	Nitrates	89	0.18	0.01	0.03	6.28
Isosorbide dinitrate 10mg tablets : 16

Prescribing where Hill Lane Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Permethrin☰	1	Parasiticidal preparations	5	0.20	0.84	0.25	-2.53
Permethrin 5% cream : 1
Finasteride☰	76	Male sex hormones and antagonists	139	0.55	0.82	0.12	-2.36
Finasteride 5mg tablets : 76
Naproxen☰	216	Non-steroidal anti-inflammatory drugs	477	0.45	0.69	0.10	-2.32
Naproxen 250mg tablets : 49 Naproxen 500mg tablets : 154 Naproxen 500mg / Esomeprazole 20mg modified-release tablets : 1 Naproxen 250mg gastro-resistant tablets : 7 Naproxen 500mg gastro-resistant tablets : 5
Folic acid☰	192	Drugs used in megaloblastic anaemias	559	0.34	0.70	0.16	-2.24
Folic acid 5mg tablets : 189 Folic acid 2.5mg/5ml oral solution sugar free : 3
Codeine phosphate☰	0	Cough suppressants	1	0.00	0.76	0.35	-2.18