Static outliers for Bradley Stoke 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 Bradley Stoke Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Perindopril arginine with diuretic☰	56	Angiotensin-converting enzyme inhibitors	2880	0.02	0.00	0.00	7.70
Perindopril arginine 5mg / Indapamide 1.25mg tablets : 54 Coversyl Arginine Plus 5mg/1.25mg tablets : 2
Triptorelin acetate☰	10	Prostate cancer and gonadorelin analogues	33	0.30	0.02	0.06	4.76
Triptorelin acetate 3mg inj vials : 5 Decapeptyl SR 3mg inj vials : 5
Dextromethorphan hydrobromide☰	3	Cough suppressants	11	0.27	0.01	0.06	4.24
Robitussin Dry Cough 7.5mg/5ml oral solution sugar free : 3
Nortriptyline☰	255	Tricyclic and related antidepressant drugs	1411	0.18	0.04	0.03	4.00
Nortriptyline 10mg tablets : 156 Nortriptyline 25mg tablets : 91 Nortriptyline 50mg tablets : 8
Formaldehyde☰	1	Preparations for warts and calluses	26	0.04	0.00	0.01	3.98
Formaldehyde (Buffered) 4% solution : 1

Prescribing where Bradley Stoke Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Theophylline☰	5	Theophylline	27	0.19	0.83	0.25	-2.63
Uniphyllin Continus 400mg tablets : 2 Uniphyllin Continus 200mg tablets : 3
Ciprofloxacin☰	28	Quinolones	55	0.51	0.86	0.15	-2.35
Ciprofloxacin 250mg tablets : 4 Ciprofloxacin 500mg tablets : 24
Lansoprazole☰	604	Proton pump inhibitors	4138	0.15	0.44	0.16	-1.84
Lansoprazole 30mg gastro-resistant capsules : 380 Lansoprazole 15mg gastro-resistant capsules : 194 Lansoprazole 15mg orodispersible tablets : 4 Lansoprazole 30mg orodispersible tablets : 26
Vitamin A☰	3	Vitamin A	12	0.25	0.84	0.35	-1.70
Vitamins A and D capsules BPC 1973 : 3
Naftidrofuryl oxalate☰	0	Peripheral vasodilators and related drugs	4	0.00	0.66	0.39	-1.69