Static outliers for Langley Health Centre

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 Langley Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Methylprednisolone☰	15	Use of corticosteroids	510	0.03	0.00	0.00	9.91
Methylprednisolone 2mg tablets : 10 Methylprednisolone 4mg tablets : 5
Opium and morphine☰	4	Antimotility drugs	150	0.03	0.00	0.00	9.86
Kaolin and Morphine mixture : 4
Benperidol☰	24	Antipsychotic drugs	1687	0.01	0.00	0.00	6.14
Benperidol 250microgram tablets : 24
Imipramine hydrochloride☰	114	Tricyclic and related antidepressant drugs	1723	0.07	0.01	0.01	5.70
Imipramine 10mg tablets : 94 Imipramine 25mg tablets : 20
Co-danthrusate (Dantron/docusate sodium)☰	1	Stimulant laxatives	693	0.00	0.00	0.00	5.41
Co-danthrusate 50mg/60mg/5ml oral suspension sugar free : 1

Prescribing where Langley Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gamolenic acid☰	0	Preparations for eczema	3	0.00	0.90	0.30	-3.03
Somatropin☰	1	Hypothalamic & anterior pituitary hormone & antioestrogens	4	0.25	0.90	0.27	-2.39
Genotropin 12mg inj cartridges : 1
Mercaptopurine☰	0	Antimetabolites	16	0.00	0.80	0.35	-2.31
Loperamide hydrochloride☰	146	Antimotility drugs	150	0.97	1.00	0.01	-2.06
Loperamide 2mg capsules : 115 Loperamide 1mg/5ml oral solution sugar free : 2 Imodium Instant Melts 2mg orodispersible tablets : 1 Loperamide 2mg orodispersible tablets sugar free : 4 Loperamide 2mg tablets : 18 Imodium Instants 2mg orodispersible tablets : 6
Methylprednisolone acetate☰	0	Local corticosteroid injections	3	0.00	0.73	0.39	-1.87