Static outliers for Hill Barton 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 Hill Barton Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Podophyllotoxin	1	Preparations for warts and calluses	1	1.00	0.05	0.14	6.99
Warticon 0.5% solution : 1
Clobetasone butyrate	123	Topical corticosteroids	310	0.40	0.13	0.05	5.47
Clobetasone 0.05% cream : 32 Eumovate 0.05% cream : 57 Clobet 0.05%/Oxytetracycline 3% /Nystatin 100,000units/g crm : 12 Clobetasone 0.05% ointment : 7 Eumovate 0.05% ointment : 10 Trimovate cream : 5
Pramipexole	44	Dopaminergic drugs used in parkinsonism	64	0.69	0.12	0.12	4.83
Pramipexole 88microgram tablets : 42 Pramipexole 180microgram tablets : 2
Ibuprofen	100	Non-steroidal anti-inflammatory drugs	234	0.43	0.11	0.07	4.78
Ibuprofen 200mg tablets : 49 Ibuprofen 400mg tablets : 51
Nabumetone	6	Non-steroidal anti-inflammatory drugs	234	0.03	0.00	0.01	4.67
Nabumetone 500mg tablets : 6

Prescribing where Hill Barton Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Senna	33	Stimulant laxatives	319	0.10	0.55	0.14	-3.22
Senna 7.5mg tablets : 32 Senna 7.5mg/5ml oral solution sugar free : 1
Fusidic acid	4	Antibacterial preparations also used systemically	17	0.24	0.72	0.15	-3.18
Fusidic acid 2% cream : 4
Lidocaine hydrochloride	10	Local anaesthetics	20	0.50	0.91	0.14	-2.93
Lidocaine 20mg/2ml (1%) solution for injection ampoules : 2 Ralvo 700mg medicated plasters : 1 Lidocaine 50mg/5ml (1%) solution for injection ampoules : 4 Emla 5% cream : 3
Naproxen	93	Non-steroidal anti-inflammatory drugs	234	0.40	0.69	0.10	-2.87
Naproxen 250mg tablets : 70 Naproxen 500mg tablets : 13 Naproxen 250mg gastro-resistant tablets : 3 Naproxen 500mg gastro-resistant tablets : 7
Dexamethasone	9	Otitis externa	20	0.45	0.78	0.13	-2.52
Otomize ear spray : 9