Static outliers for Hathaway 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 Hathaway Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Hydromorphone hydrochloride☰	25	Opioid analgesics	2970	0.01	0.0	0.00	6.56
Hydromorphone 8mg modified-release capsules : 3 Hydromorphone 2mg modified-release capsules : 7 Hydromorphone 1.3mg capsules : 10 Hydromorphone 16mg modified-release capsules : 5
Gluten free/low protein biscuits☰	18	Foods for special diets	252	0.07	0.0	0.01	6.27
Mevalia low protein frollini biscuits : 7 Mevalia low protein fruit bar : 6 Mevalia low protein cookies : 5
Paracetamol combined preparations☰	13	Non-opioid analgesics and compound preparations	3678	0.00	0.0	0.00	4.76
Solpadeine Max soluble tablets : 7 Solpadeine Plus soluble tablets : 6
Gluten free/low protein mixes☰	7	Foods for special diets	252	0.03	0.0	0.01	4.62
Mevalia low protein burger mix : 7
Nizatidine☰	23	H2-Receptor antagonists	32	0.72	0.1	0.16	3.75
Nizatidine 300mg capsules : 13 Nizatidine 150mg capsules : 10

Prescribing where Hathaway Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Midazolam hydrochloride☰	0	Drugs used in status epilepticus	22	0.00	0.79	0.30	-2.62
Famotidine☰	8	H2-Receptor antagonists	32	0.25	0.78	0.23	-2.27
Famotidine 20mg tablets : 2 Famotidine 40mg tablets : 6
Medroxyprogesterone acetate☰	68	Parenteral progestogen-only contraceptives	116	0.59	0.88	0.16	-1.82
Depo-Provera 150mg/1ml inj pre-filled syringes : 60 Medroxyprogesterone 104mg/0.65ml inj pf disposable devices : 1 Sayana Press 104mg/0.65ml inj pre-filled disposable devices : 7
Amoxicillin☰	256	Broad-spectrum penicillins	383	0.67	0.81	0.09	-1.66
Amoxicillin 500mg capsules : 192 Amoxicillin 250mg/5ml oral suspension sugar free : 59 Amoxicillin 125mg/5ml oral suspension : 2 Amoxicillin 125mg/5ml oral suspension sugar free : 2 Amoxicillin 250mg capsules : 1
Sodium picosulfate☰	0	Bowel cleansing preparations	1	0.00	0.68	0.44	-1.54