Static outliers for Leek Health 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 Leek Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Inosine pranobex☰	8	Herpes simplex and varicella-zoster	58	0.14	0.00	0.00	90.98
Inosine acedoben dimepranol 500mg tablets : 8
Salicylic acid☰	1	Drugs for oral ulceration and inflammation	47	0.02	0.00	0.00	9.70
Salicylic acid 1% / Rhubarb extract 5% oromucosal solution : 1
Budesonide☰	115	Drugs used in nasal allergy	610	0.19	0.01	0.02	9.38
Budesonide 64micrograms/dose nasal spray : 114 Rhinocort Aqua 64 nasal spray : 1
Arnica montana☰	2	Rubefacients, topical NSAIDS, capsaicin and poultice	851	0.00	0.00	0.00	5.74
Atrogel Arnica gel : 2
Exenatide☰	28	Other antidiabetic drugs	566	0.05	0.01	0.01	4.63
Bydureon 2mg inj pre-filled pens : 2 Byetta 10micrograms/0.04ml inj 2.4ml pre-filled pens : 21 Bydureon BCise 2mg/0.85ml prolonged-release inj pf pens : 5

Prescribing where Leek Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Carbocisteine☰	151	Mucolytics	239	0.63	0.97	0.08	-4.22
Carbocisteine 375mg capsules : 137 Carbocisteine 250mg/5ml oral solution : 8 Mucodyne 375mg capsules : 6
Potassium citrate☰	0	Drugs used in urological pain	1	0.00	0.93	0.24	-3.87
Aciclovir☰	41	Herpes simplex and varicella-zoster	58	0.71	0.95	0.07	-3.59
Aciclovir 800mg dispersible tablets : 1 Aciclovir 200mg dispersible tablets : 1 Aciclovir 400mg/5ml oral suspension sugar free : 4 Aciclovir 400mg tablets : 18 Aciclovir 800mg tablets : 12 Aciclovir 200mg tablets : 5
Other amino acidandnutritional agent preparations☰	4	Amino acids and nutritional agents	9	0.44	0.95	0.20	-2.58
ProSource liquid 30ml sachets (4 flavours) : 4
Budesonide☰	0	Corticosteroids	14	0.00	0.70	0.34	-2.08