Static outliers for Pathfields Medical Group

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 Pathfields Medical Group is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Etodolac☰	230	Non-steroidal anti-inflammatory drugs	2769	0.08	0.01	0.02	5.01
Etodolac 600mg modified-release tablets : 228 Etodolac 300mg capsules : 2
Ferrous gluconate☰	416	Oral iron	1417	0.29	0.03	0.05	4.81
Ferrous gluconate 300mg tablets : 416
Levofloxacin☰	60	Quinolones	130	0.46	0.05	0.09	4.66
Levofloxacin 500mg tablets : 48 Levofloxacin 250mg tablets : 12
Triptorelin acetate☰	29	Prostate cancer and gonadorelin analogues	106	0.27	0.02	0.06	4.26
Decapeptyl SR 3mg inj vials : 29
Methocarbamol☰	319	Skeletal muscle relaxants	452	0.71	0.08	0.15	4.08
Methocarbamol 750mg tablets : 315 Robaxin 750 tablets : 4

Prescribing where Pathfields Medical Group is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	102	Skeletal muscle relaxants	452	0.23	0.83	0.18	-3.26
Baclofen 10mg tablets : 101 Baclofen 5mg/5ml oral solution sugar free : 1
Ciprofloxacin☰	69	Quinolones	130	0.53	0.86	0.15	-2.20
Ciprofloxacin 250mg tablets : 51 Ciprofloxacin 750mg tablets : 2 Ciprofloxacin 250mg/5ml oral suspension : 1 Ciprofloxacin 500mg tablets : 15
Oral rehydration salts☰	13	Oral sodium and water	92	0.14	0.68	0.31	-1.75
Dioralyte oral powder sachets plain : 8 Dioralyte oral powder sachets blackcurrant : 5
Lansoprazole☰	1811	Proton pump inhibitors	11196	0.16	0.44	0.16	-1.74
Lansoprazole 30mg gastro-resistant capsules : 1134 Lansoprazole 15mg gastro-resistant capsules : 586 Lansoprazole 15mg orodispersible tablets : 52 Lansoprazole 15mg/5ml oral suspension : 1 Zoton FasTab 15mg : 12 Lansoprazole 30mg orodispersible tablets : 26
Losartan potassium☰	488	Angiotensin-II receptor antagonists	2783	0.18	0.50	0.19	-1.74
Losartan 25mg tablets : 88 Losartan 50mg tablets : 180 Losartan 100mg tablets : 208 Losartan 12.5mg tablets : 9 Cozaar 100mg tablets : 3