Static outliers for Red Roofs Surgery

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 Red Roofs Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Leflunomide	5	Rheumatic disease suppressant drugs	11	0.45	0.05	0.05	7.88
Leflunomide 20mg tablets : 5
Low protein desserts	8	Foods for special diets	278	0.03	0.00	0.01	4.97
Taranis Pause low protein dessert strawberry : 4 Taranis Pause low protein dessert caramel : 4
Low protein meals	11	Foods for special diets	278	0.04	0.00	0.01	4.74
Promin low protein X-Pot rogan style curry : 2 Promin low protein X-Pot beef & tomato : 3 Promin low protein X-Pot all day scramble : 3 Promin low protein X-Pot chip shop curry : 3
Famciclovir	6	Herpes simplex and varicella-zoster	67	0.09	0.01	0.02	4.32
Famciclovir 250mg tablets : 1 Famciclovir 500mg tablets : 5
Fluocinonide	11	Topical corticosteroids	973	0.01	0.00	0.00	4.02
Metosyn 0.05% ointment : 6 Fluocinonide 0.05% ointment : 5

Prescribing where Red Roofs Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Methotrexate	0	Rheumatic disease suppressant drugs	11	0.00	0.58	0.15	-3.75

Sulfasalazine	13	Aminosalicylates	204	0.06	0.33	0.14	-1.88
Sulfasalazine 500mg tablets : 2 Salazopyrin EN-Tabs 500mg : 11
Mirabegron	57	Drugs for urinary frequency enuresis and incontinence	797	0.07	0.22	0.09	-1.65
Mirabegron 50mg modified-release tablets : 38 Betmiga 50mg modified-release tablets : 3 Mirabegron 25mg modified-release tablets : 16
Fluorouracil (Sunscreen)	1	Sunscreening preparations	31	0.03	0.43	0.29	-1.36
Efudix 5% cream : 1
Metoclopramide hydrochloride	18	Drugs used in nausea and vertigo	771	0.02	0.11	0.07	-1.35
Metoclopramide 10mg tablets : 14 Metoclopramide 10mg/2ml solution for injection ampoules : 4