Static outliers for Woosehill 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 Woosehill Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Magnesium carbonate☰	6	Antacids and simeticone	6	1.00	0.0	0.06	17.59
Magnesium carbonate heavy 500mg capsules : 6
Mizolastine☰	26	Antihistamines	1043	0.02	0.0	0.00	4.79
Mizolastine 10mg modified-release tablets : 26
Ketoprofen☰	7	Non-steroidal anti-inflammatory drugs	426	0.02	0.0	0.00	4.74
Ketoprofen 200mg modified-release capsules : 4 Ketoprofen 100mg modified-release capsules : 3
Colestipol hydrochloride☰	5	Lipid-regulating drugs	4045	0.00	0.0	0.00	4.65
Colestid Orange 5g granules sachets : 1 Colestipol 5g granules sachets sugar free : 4
Bupropion hydrochloride☰	7	Nicotine dependence	7	1.00	0.1	0.20	4.47
Bupropion 150mg modified-release tablets : 7

Prescribing where Woosehill Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Levothyroxine sodium☰	2413	Thyroid hormones	2445	0.99	1.00	0.00	-3.95
Levothyroxine sodium 25microgram tablets : 762 Levothyroxine sodium 50microgram tablets : 787 Levothyroxine sodium 75microgram tablets : 38 Levothyroxine sodium 100microgram tablets : 818 Levothyroxine sodium 25micrograms/5ml soln sugar free : 2 Levothyroxine sodium 12.5microgram tablets : 6
Acamprosate calcium☰	0	Alcohol dependence	3	0.00	0.83	0.31	-2.70
Salicylic acid☰	0	Preparations for warts and calluses	3	0.00	0.69	0.31	-2.20
Clotrimazole☰	6	Antifungal preparations	77	0.08	0.41	0.16	-2.03
Clotrimazole 1% solution : 1 Clotrimazole 1% cream : 5
Terbinafine hydrochloride☰	13	Other antifungals	14	0.93	0.99	0.03	-1.87
Terbinafine 250mg tablets : 13