Static outliers for Woodview Medical 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 Woodview Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Gluten free/low protein grains/flours	18	Foods for special diets	171	0.11	0.00	0.01	17.60
Mevalia low protein rice replacer : 3 Promin low protein imitation rice pudding 69g sachets apple : 5 Promin low protein imitation rice pudding 69g sachets banana : 5 Promin low protein imitation rice pudding 69g sach : 5
Gluten free/low protein cereals	11	Foods for special diets	171	0.06	0.00	0.01	12.13
Promin low protein hot breakfast powder 56g sachets original : 2 Promin low protein hot breakfast powder 57g sach : 4 Promin low protein hot breakfast powder 57g sachets banana : 5
Low protein mixes	33	Foods for special diets	171	0.19	0.01	0.02	7.46
Promin low protein sausage mix 30g sachets original : 1 Fate low protein all purpose mix : 16 Fate low protein plain cake mix : 6 Loprofin low protein mix : 5 Promin low protein burger mix 62g sachets lamb & mint : 5
Empagliflozin/metformin	253	Other antidiabetic drugs	2413	0.10	0.00	0.02	5.33
Empagliflozin 5mg / Metformin 1g tablets : 63 Empagliflozin 12.5mg / Metformin 1g tablets : 144 Empagliflozin 5mg / Metformin 850mg tablets : 23 Empagliflozin 12.5mg / Metformin 850mg tablets : 23
Gluten free/low protein biscuits	10	Foods for special diets	171	0.06	0.00	0.01	5.09
Mevalia low protein frollini biscuits : 5 Mevalia low protein fruit bar : 5

Prescribing where Woodview Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Medroxyprogesterone acetate	5	Parenteral progestogen-only contraceptives	28	0.18	0.88	0.16	-4.32
Medroxyprogesterone 150mg/1ml inj pre-filled syringes : 2 Depo-Provera 150mg/1ml inj pre-filled syringes : 3
Combined ethinylestradiol 30mcg	125	Combined hormonal contraceptives	218	0.57	0.81	0.07	-3.20
Levest 150/30 tablets (Morningside) : 44 Lucette 0.03mg/3mg tablets : 2 Ethinylestradiol 30microg / Levonorgestrel 150microg tab : 1 Maexeni 150microgram/30microgram tablets : 1 Yacella 0.03mg/3mg tablets : 1 Microgynon 30 ED tablets : 14 Rigevidon tablets : 9 Dretine 0.03mg/3mg tablets : 24 Microgynon 30 tablets : 5 Yasmin tablets : 5 Millinette 30microgram/75microgram tablets : 19
Cabergoline	0	Bromocriptine and other dopaminergic drugs	1	0.00	0.86	0.27	-3.16

Benzydamine hydrochloride	14	Drugs for oral ulceration and inflammation	36	0.39	0.83	0.18	-2.36
Benzydamine 0.15% mouthwash sugar free : 2 Difflam Oral Rinse 0.15% solution : 1 Benzydamine 0.15% oromucosal spray sugar free : 11
Methylprednisolone acetate	0	Local corticosteroid injections	43	0.00	0.73	0.39	-1.87