Static outliers for Devon Square 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 Devon Square Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Benzocaine☰	1	Drugs for oral ulceration and inflammation	6	0.17	0.00	0.02	8.73
Benzocaine 20% dental gel sugar free : 1
Benzalkonium chloride☰	2	Barrier preparations	2	1.00	0.05	0.14	6.69
Drapolene cream : 2
Levothyroxine sodium and liothyronine☰	4	Thyroid hormones	1715	0.00	0.00	0.00	5.47
Armour Thyroid 90mg (1 and a half grains) tablets : 1 Erfa Thyroid 30mg (half grain) tablets : 3
Magnesium trisilicate☰	3	Antacids and simeticone	4	0.75	0.03	0.14	5.28
Magnesium trisilicate oral suspension : 3
Clemastine fumarate☰	1	Antihistamines	432	0.00	0.00	0.00	4.53
Clemastine 1mg tablets : 1

Prescribing where Devon Square Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Levothyroxine sodium☰	1698	Thyroid hormones	1715	0.99	1.00	0.00	-2.86
Levothyroxine sodium 25microgram tablets : 549 Levothyroxine sodium 50microgram tablets : 518 Levothyroxine sodium 75microgram tablets : 40 Levothyroxine sodium 100microgram tablets : 591
Glycopyrronium bromide☰	0	Antimuscarinic drugs	14	0.00	0.82	0.36	-2.30
Mesalazine (Systemic)☰	39	Aminosalicylates	115	0.34	0.64	0.15	-2.05
Pentasa 2g modified-release granules sachets : 2 Octasa 800mg MR gastro-resistant tablets : 4 Pentasa 500mg modified-release tablets : 8 Asacol 800mg MR gastro-resistant tablets : 6 Pentasa 1g modified-release tablets : 19
Ramipril☰	800	Angiotensin-converting enzyme inhibitors	2226	0.36	0.69	0.17	-1.98
Ramipril 1.25mg capsules : 99 Ramipril 2.5mg capsules : 268 Ramipril 5mg capsules : 192 Ramipril 10mg capsules : 218 Ramipril 1.25mg tablets : 2 Ramipril 2.5mg tablets : 1 Ramipril 10mg tablets : 14 Ramipril 5mg tablets : 6
Allopurinol☰	283	Gout and cytotoxic induced hyperiuicaemia	357	0.79	0.89	0.05	-1.91
Allopurinol 100mg tablets : 194 Allopurinol 300mg tablets : 89