Static outliers for Bampton Surgery

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 Bampton Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Wool alcohols☰	15	Emollients	180	0.08	0.00	0.01	8.01
Hydrous ointment : 15
Clozapine☰	5	Antipsychotic drugs	408	0.01	0.00	0.00	7.52
Denzapine 100mg tablets : 5
Miconazole nitrate☰	20	Vaginal and vulval infections	73	0.27	0.01	0.04	7.22
Gyno-Daktarin 2% vaginal cream : 14 Miconazole 2% vaginal cream : 6
Lidocaine hydrochloride☰	6	Soothing haemorrhoidal preparations	6	1.00	0.06	0.15	6.25
Zinc oxide 6.6% / Lidocaine 0.7% ointment : 1 Germoloids cream : 5
Olmesartan medoxomil☰	496	Angiotensin-II receptor antagonists	2276	0.22	0.02	0.03	5.94
Olmesartan medoxomil 10mg tablets : 210 Olmesartan medoxomil 20mg tablets : 200 Olmesartan medoxomil 40mg tablets : 86

Prescribing where Bampton Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Potassium citrate☰	0	Drugs used in urological pain	1	0.00	0.93	0.24	-3.87
Zinc oxide☰	0	Soothing haemorrhoidal preparations	6	0.00	0.77	0.27	-2.89
Amoxicillin☰	330	Broad-spectrum penicillins	562	0.59	0.81	0.09	-2.60
Amoxicillin 500mg capsules : 249 Amoxicillin 250mg/5ml oral suspension sugar free : 65 Amoxicillin 125mg/5ml oral suspension sugar free : 2 Amoxicillin 250mg/5ml oral suspension : 1 Amoxicillin 125mg/5ml oral suspension : 3 Amoxicillin 250mg capsules : 10
Clotrimazole☰	48	Vaginal and vulval infections	73	0.66	0.90	0.10	-2.52
Clotrimazole 200mg pessaries : 1 Clotrimazole 10% vaginal cream : 1 Canesten Combi 500mg pessary and 2% cream : 1 Clotrimazole 500mg pessary and Clotrimazole 2% cream : 25 Clotrimazole 500mg pessaries : 10 Clotrimazole 2% cream : 10
Alendronic acid☰	633	Bisphosphonates and other drugs	946	0.67	0.87	0.09	-2.20
Alendronic acid 70mg tablets : 617 Alendronic acid 70mg effervescent tablets sugar free : 16