Static outliers for Dr. J Barrell & Partners

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 Dr. J Barrell & Partners is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Granisetron☰	6	Drugs used in nausea and vertigo	787	0.01	0.00	0.00	22.85
Granisetron 3.1mg/24hours transdermal patches : 2 Sancuso 3.1mg/24hours transdermal patches : 4
Cholesterol☰	24	Drugs used in metabolic disorders	24	1.00	0.00	0.05	18.91
Cholesterol 1g oral powder sachets : 24
Combined mestranol☰	1	Combined hormonal contraceptives	211	0.00	0.00	0.00	7.12
Norinyl-1 tablets : 1
Olmesartan medoxomil/amlodipine☰	77	Angiotensin-II receptor antagonists	3858	0.02	0.00	0.00	6.03
Olmesartan medoxomil 20mg / Amlodipine 5mg tablets : 37 Olmesartan medoxomil 40mg / Amlodipine 10mg tablets : 17 Sevikar 40mg/10mg tablets : 7 Olmesartan medoxomil 40mg / Amlodipine 5mg tablets : 11 Sevikar 40mg/5mg tablets : 5
Exenatide☰	113	Other antidiabetic drugs	1970	0.06	0.01	0.01	5.45
Exenatide 2mg inj pre-filled disposable devices : 31 Bydureon BCise 2mg/0.85ml prolonged-release inj pf pens : 40 Exenatide 2mg/0.85ml prolonged-release inj pf dispos dev : 18 Bydureon 2mg inj pre-filled pens : 24

Prescribing where Dr. J Barrell & Partners is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Amlodipine☰	3158	Calcium-channel blockers	8013	0.39	0.75	0.11	-3.18
Amlodipine 5mg tablets : 2112 Amlodipine 10mg tablets : 1042 Amlodipine 5mg/5ml oral suspension sugar free : 1 Istin 5mg tablets : 3
Bendroflumethiazide☰	440	Thiazides and related diuretics	3265	0.13	0.58	0.16	-2.80
Bendroflumethiazide 2.5mg tablets : 428 Bendroflumethiazide 5mg tablets : 12
Glycopyrronium bromide☰	0	Antimuscarinic drugs	7	0.00	0.82	0.36	-2.30
Salicylic acid☰	0	Preparations for warts and calluses	4	0.00	0.69	0.31	-2.20
Ramipril☰	2260	Angiotensin-converting enzyme inhibitors	6919	0.33	0.69	0.17	-2.18
Ramipril 1.25mg capsules : 272 Ramipril 2.5mg capsules : 629 Ramipril 5mg capsules : 526 Ramipril 10mg capsules : 833