Static outliers for Church Street 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 Church Street Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Meningococcal B vaccine☰	2	Vaccines and antisera	9	0.22	0.00	0.01	25.74
Bexsero vacc inj 0.5ml pre-filled syringes : 2
Ketoprofen☰	185	Rubefacients, topical NSAIDS, capsaicin and poultice	429	0.43	0.02	0.06	6.78
Ketoprofen 2.5% gel : 185
Co-flumactone (Hydroflumethiazide/spironolactone)☰	2	Potassium sparing diuretics and compounds	19	0.11	0.00	0.02	6.62
Co-flumactone 50mg/50mg tablets : 2
Miconazole nitrate☰	18	Vaginal and vulval infections	78	0.23	0.01	0.04	6.01
Miconazole 2% vaginal cream : 18
Benzalkonium chloride☰	5	Barrier preparations	6	0.83	0.05	0.14	5.51
Drapolene cream : 5

Prescribing where Church Street Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Doxazosin mesilate☰	352	Alpha-adrenoceptor blocking drugs	379	0.93	0.99	0.02	-3.13
Doxazosin 1mg tablets : 34 Doxazosin 2mg tablets : 111 Doxazosin 4mg tablets : 195 Doxazosin 8mg modified-release tablets : 2 Doxazosin 8mg tablets : 4 Doxazosin 4mg modified-release tablets : 6
Clotrimazole☰	49	Vaginal and vulval infections	78	0.63	0.90	0.10	-2.83
Clotrimazole 100mg pessaries : 2 Clotrimazole 10% vaginal cream : 1 Canesten 500mg pessaries/vaginal pessaries : 1 Clotrimazole 500mg pessaries : 22 Canesten Combi 500mg pessary and 2% cream : 7 Clotrimazole 2% cream : 11 Clotrimazole 500mg pessary and Clotrimazole 2% cream : 5
Amoxicillin☰	288	Broad-spectrum penicillins	479	0.60	0.81	0.09	-2.44
Amoxicillin 500mg capsules : 187 Amoxicillin 250mg/5ml oral suspension sugar free : 88 Amoxicillin 125mg/5ml oral suspension : 1 Amoxicillin 250mg capsules : 7 Amoxicillin 125mg/5ml oral suspension sugar free : 5
Solifenacin☰	50	Drugs for urinary frequency enuresis and incontinence	701	0.07	0.33	0.12	-2.21
Solifenacin 10mg tablets : 23 Solifenacin 5mg tablets : 27
Moxonidine☰	0	Centrally-acting antihypertensive drugs	8	0.00	0.64	0.34	-1.92