Static outliers for Clevedon 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 Clevedon Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Meningococcal A + C + W135 + Y vaccine☰	3	Vaccines and antisera	23	0.13	0.00	0.02	7.18
Menveo vaccine inj 0.5ml vials : 3
Hydromorphone hydrochloride☰	21	Opioid analgesics	3135	0.01	0.00	0.00	5.19
Hydromorphone 4mg modified-release capsules : 6 Hydromorphone 2mg modified-release capsules : 10 Hydromorphone 1.3mg capsules : 5
Dapagliflozin/metformin☰	53	Other antidiabetic drugs	1015	0.05	0.00	0.01	4.47
Dapagliflozin 5mg / Metformin 1g tablets : 46 Dapagliflozin 5mg / Metformin 850mg tablets : 7
Nefopam hydrochloride☰	294	Non-opioid analgesics and compound preparations	3906	0.08	0.01	0.02	3.92
Nefopam 30mg tablets : 294
Mercaptamine☰	1	Drugs used in metabolic disorders	1	1.00	0.07	0.25	3.66
Mercaptamine 50mg capsules : 1

Prescribing where Clevedon Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Emollient bath and shower preparations☰	1	Emollient bath and shower preparations	13	0.08	0.61	0.21	-2.52
Aqueous cream : 1
Glycopyrronium bromide☰	0	Antimuscarinic drugs	3	0.00	0.82	0.36	-2.30
Amoxicillin☰	181	Broad-spectrum penicillins	286	0.63	0.81	0.09	-2.07
Amoxicillin 500mg capsules : 126 Amoxicillin 250mg/5ml oral suspension sugar free : 46 Amoxicillin 250mg capsules : 1 Amoxicillin 250mg/5ml oral suspension : 3 Amoxicillin 125mg/5ml oral suspension sugar free : 5
Timolol and bimatoprost☰	16	Treatment of glaucoma	1267	0.01	0.10	0.05	-1.68
Bimatoprost 300microg/Timolol 5mg/ml eye dps 0.4ml : 1 Ganfort 0.3mg/ml / 5mg/ml eye drops 0.4ml unit dose : 1 Bimatoprost 300micrograms/ml / Timolol 5mg/ml eye drops : 4 Ganfort 0.3mg/ml / 5mg/ml eye drops : 10
Medroxyprogesterone acetate☰	0	Progestogens	2	0.00	0.65	0.46	-1.42