Static outliers for Essex House Medical Centre, Chard

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 Essex House Medical Centre, Chard is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Flupentixol hydrochloride☰	42	Antipsychotic drugs	541	0.08	0.00	0.01	8.79
Flupentixol 3mg tablets : 42
Nicotinamide☰	3	Topical preparations for acne	52	0.06	0.00	0.01	7.76
Nicotinamide 4% gel : 3
Magnesium hydroxide☰	3	Antacids and simeticone	3	1.00	0.03	0.14	6.80
Magnesium hydroxide 7.45-8.35% oral suspension BP : 3
Denosumab☰	51	Bisphosphonates and other drugs	404	0.13	0.01	0.02	6.19
Denosumab 60mg/1ml inj pre-filled syringes : 51
Methenamine hippurate☰	102	Urinary-tract infections	258	0.40	0.03	0.06	5.95
Methenamine hippurate 1g tablets : 102

Prescribing where Essex House Medical Centre, Chard is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nitrofurantoin☰	156	Urinary-tract infections	258	0.60	0.97	0.06	-5.95
Nitrofurantoin 100mg modified-release capsules : 150 Nitrofurantoin 100mg capsules : 2 Nitrofurantoin 100mg tablets : 2 Nitrofurantoin 50mg capsules : 1 Nitrofurantoin 50mg tablets : 1
Ispaghula husk☰	34	Bulk-forming laxatives	57	0.60	0.96	0.07	-4.95
Fybogel Hi-Fibre Orange 3.5g effervescent granules sachets : 4 Ispaghula husk 3.5g efferv gran sach gluten free sugar free : 27 Fybogel Orange 3.5g effervescent granules sachets SF : 3
Trimethoprim☰	29	Sulfonamides and trimethoprim	61	0.48	0.86	0.13	-3.01
Trimethoprim 100mg tablets : 4 Trimethoprim 50mg/5ml oral suspension sugar free : 4 Trimethoprim 200mg tablets : 21
Hydralazine hydrochloride☰	0	Vasodilator antihypertensive drugs	8	0.00	0.85	0.28	-3.01
Cefalexin☰	16	Cephalosporins	23	0.70	0.96	0.10	-2.58
Cefalexin 250mg capsules : 11 Cefalexin 500mg capsules : 5