Static outliers for The Bay 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 Bay Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Tolnaftate☰	7	Antifungal preparations	276	0.03	0.00	0.00	26.49
Tolnaftate 1% powder : 7
Hydrocortisone acetate☰	2	Corticosteroids	21	0.10	0.00	0.01	11.89
Colifoam 10% aerosol : 2
Acetylcysteine☰	383	Mucolytics	508	0.75	0.02	0.08	9.62
NACSYS 600mg effervescent tablets : 363 Acetylcysteine 600mg effervescent tablets sugar free : 20
Phosphates☰	1	Bowel cleansing preparations	3	0.33	0.01	0.07	4.81
Sod dihydrogen phos 542mg/Disod hydrogen phos 240mg/ml soln : 1
Triptorelin embonate☰	106	Prostate cancer and gonadorelin analogues	282	0.38	0.02	0.07	4.71
Decapeptyl SR 22.5mg inj vials : 106

Prescribing where The Bay Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbocisteine☰	120	Mucolytics	508	0.24	0.97	0.08	-9.14
Carbocisteine 375mg capsules : 118 Carbocisteine 750mg/10ml soln 10ml sachets sugar free : 2
Amitriptyline hydrochloride☰	3233	Tricyclic and related antidepressant drugs	5168	0.63	0.84	0.08	-2.80
Amitriptyline 10mg tablets : 2276 Amitriptyline 25mg tablets : 609 Amitriptyline 50mg tablets : 342 Amitriptyline 25mg/5ml oral solution sugar free : 6
Alfentanil hydrochloride☰	0	Opioid analgesics	13	0.00	0.82	0.37	-2.21
Apixaban☰	690	Oral anticoagulants	4747	0.15	0.40	0.14	-1.79
Apixaban 2.5mg tablets : 242 Apixaban 5mg tablets : 448
Lymecycline☰	57	Tetracyclines	807	0.07	0.29	0.13	-1.70
Lymecycline 408mg capsules : 55 Tetralysal 300 capsules : 2