Static outliers for South Lawn Medical 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 South Lawn Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Paracetamol and caffeine	2	Non-opioid analgesics and compound preparations	2033	0.00	0.00	0.00	15.73
Paracetamol 500mg / Caffeine 65mg efferv tab sugar free : 2
Flumetasone pivalate	14	Otitis externa	66	0.21	0.01	0.02	10.17
Flumetasone 0.02% / Clioquinol 1% ear drops : 14
Dronabinol/cannabidiol	5	Skeletal muscle relaxants	66	0.08	0.00	0.01	8.56
Sativex oromucosal spray : 5
Arachis oil	1	Shampoos and some other scalp preparations	68	0.01	0.00	0.00	8.45
Arachis oil liquid : 1
Gluten free/low protein pasta	12	Foods for special diets	82	0.15	0.00	0.02	8.06
Promin low protein pasta shells : 2 Promin low protein pasta elbows : 2 Mevalia low protein spaghetti : 2 Mevalia low protein penne : 3 Mevalia low protein fusilli : 3

Prescribing where South Lawn Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Dexamethasone	16	Otitis externa	66	0.24	0.78	0.13	-4.09
Otomize ear spray : 16
Procyclidine hydrochloride	14	Antimuscarinic drugs used in parkinsonism	81	0.17	0.84	0.21	-3.21
Kemadrin 5mg tablets : 4 Procyclidine 5mg tablets : 10
Senna	208	Stimulant laxatives	977	0.21	0.55	0.14	-2.44
Senna 7.5mg tablets : 196 Senokot 7.5mg/5ml Syrup Pharmacy sugar free : 1 Senna 7.5mg/5ml oral solution sugar free : 6 Senna 15mg tablets : 5
Glycopyrronium bromide	0	Antimuscarinic drugs	12	0.00	0.82	0.36	-2.30

Salicylic acid	0	Preparations for warts and calluses	3	0.00	0.69	0.31	-2.20