Static outliers for The Cross Keys 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 Cross Keys Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Amoxicillin sodium☰	1	Broad-spectrum penicillins	627	0.00	0.0	0.00	20.11
Amoxicillin 500mg powder for solution for injection vials : 1
Low protein cooking aids☰	3	Foods for special diets	73	0.04	0.0	0.00	11.66
Loprofin low protein egg replacer : 2 Mevalia low protein egg replacer : 1
Low protein cereals☰	3	Foods for special diets	73	0.04	0.0	0.01	5.31
Loprofin low protein breakfast cereal flakes (2 flavours) : 3
Ramipril with calcium channel blocker☰	12	Angiotensin-converting enzyme inhibitors	3467	0.00	0.0	0.00	5.00
Felodipine 5mg modified-release / Ramipril 5mg tablets : 7 Triapin 5mg/5mg modified-release tablets : 5
Sulfadiazine☰	1	Sulfonamides and trimethoprim	138	0.01	0.0	0.00	4.38
Sulfadiazine 500mg tablets : 1

Prescribing where The Cross Keys Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Quinine sulfate☰	83	Antimalarials	127	0.65	0.89	0.14	-1.69
Quinine sulfate 200mg tablets : 40 Quinine sulfate 300mg tablets : 43
Pregabalin☰	254	Control of epilepsy	1862	0.14	0.27	0.08	-1.68
Pregabalin 25mg capsules : 51 Pregabalin 50mg capsules : 49 Pregabalin 75mg capsules : 56 Pregabalin 100mg capsules : 52 Pregabalin 300mg capsules : 9 Lyrica 300mg capsules : 3 Pregabalin 200mg capsules : 10 Pregabalin 150mg capsules : 24
Other food for special diet preparations☰	17	Foods for special diets	73	0.23	0.65	0.25	-1.67
Vitajoule powder : 1 PKU gel powder 24g sachets orange : 1 Phlexy-10 tablets : 3 Phlexy-Vits tablets : 3 Phlexy-10 drink mix 20g sachets apple & blackcurrant : 3 PKU express20 powder 34g sachets orange : 6
Ivermectin☰	1	Topical preparation for rosacea	2	0.50	0.88	0.24	-1.59
Soolantra 10mg/g cream : 1
Umeclidinium bromide/vilanterol☰	2	Compound bronchodilator preparations	135	0.01	0.50	0.31	-1.58
Anoro Ellipta 55microg/dose / 22microg/dose dry pdr inh : 2