Static outliers for Hillview Medical Centre

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 Hillview Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Stiripentol☰	5	Control of epilepsy	1616	0.00	0.00	0.00	4.97
Stiripentol 250mg oral powder sachets : 5
Saxagliptin☰	68	Other antidiabetic drugs	531	0.13	0.01	0.02	4.75
Saxagliptin 5mg tablets : 56 Saxagliptin 2.5mg tablets : 12
Estradiol and estriol with progestogen☰	11	Oestrogens and Hormone Replacement Therapy	368	0.03	0.00	0.01	4.52
Trisequens tablets : 11
Insulin glulisine☰	52	Short-acting insulins	196	0.27	0.03	0.05	4.30
Apidra 100units/ml inj 3ml pre-filled SoloStar pens : 48 Insulin glulisine 100units/ml inj 3ml cartridges : 2 Apidra 100units/ml solution for injection 3ml cartridges : 2
Semaglutide☰	133	Other antidiabetic drugs	531	0.25	0.04	0.05	4.15
Ozempic 0.5mg/0.37ml inj 1.5ml pre-filled pens : 82 Ozempic 1mg/0.74ml inj 3ml pre-filled pens : 33 Semaglutide 14mg tablets : 1 Semaglutide 3mg tablets : 1 Semaglutide 7mg tablets : 1 Ozempic 0.25mg/0.19ml inj 1.5ml pre-filled pens : 15

Prescribing where Hillview Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Filgrastim☰	0	Drugs used in neutropenia	1	0.00	0.86	0.36	-2.41
Salicylic acid☰	0	Preparations for warts and calluses	2	0.00	0.69	0.31	-2.20
Water for injection☰	5	Electrolytes and water	20	0.25	0.82	0.26	-2.18
Water for injections 10ml ampoules : 1 Water for injections 10ml vials : 1 Water for injections 20ml ampoules : 3
Bisoprolol fumarate☰	1297	Beta-adrenoceptor blocking drugs	2520	0.51	0.65	0.08	-1.70
Bisoprolol 5mg tablets : 341 Bisoprolol 10mg tablets : 140 Bisoprolol 2.5mg tablets : 481 Bisoprolol 3.75mg tablets : 38 Bisoprolol 7.5mg tablets : 86 Bisoprolol 1.25mg tablets : 211
Tacrolimus☰	0	Corticosteroids and other immunosuppressants	4	0.00	0.62	0.40	-1.56