Static outliers for Dr Robinson & 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 Robinson & Partners is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Erdosteine	19	Mucolytics	223	0.09	0.00	0.01	7.36
Erdosteine 300mg capsules : 19
Felodipine	1740	Calcium-channel blockers	3081	0.56	0.08	0.08	5.75
Felodipine 5mg modified-release tablets : 622 Felodipine 10mg modified-release tablets : 532 Felodipine 2.5mg modified-release tablets : 586
Ethosuximide	18	Control of epilepsy	1556	0.01	0.00	0.00	4.14
Ethosuximide 250mg capsules : 18
Amorolfine hydrochloride	24	Antifungal preparations	52	0.46	0.11	0.09	3.75
Amorolfine 5% medicated nail lacquer : 24
Lidocaine	14	Local anaesthetics	32	0.44	0.07	0.11	3.37
Lidocaine 5% ointment : 8 Lidocaine 4% cream : 3 LMX 4 cream : 3

Prescribing where Dr Robinson & Partners is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Amlodipine	931	Calcium-channel blockers	3081	0.30	0.75	0.11	-3.99
Amlodipine 5mg tablets : 498 Amlodipine 10mg tablets : 423 Amlodipine 2.5mg tablets : 10
Carbocisteine	152	Mucolytics	223	0.68	0.97	0.08	-3.61
Carbocisteine 375mg capsules : 148 Carbocisteine 250mg/5ml oral solution : 4
Lidocaine hydrochloride	18	Local anaesthetics	32	0.56	0.91	0.14	-2.48
Lidocaine 40mg/2ml (2%) solution for injection ampoules : 3 Lidocaine 5% medicated plasters : 10 Emla 5% cream : 5
Tacrolimus	2	Drugs affecting the immune response	6	0.33	0.81	0.21	-2.29
Tacrolimus 0.1% ointment : 1 Protopic 0.03% ointment : 1
Procyclidine hydrochloride	6	Antimuscarinic drugs used in parkinsonism	16	0.38	0.84	0.21	-2.25
Procyclidine 5mg tablets : 1 Kemadrin 5mg tablets : 5