Static outliers for Saltley And Fernbank Medical Practice

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 Saltley And Fernbank Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cefuroxime axetil☰	5	Cephalosporins	15	0.33	0.00	0.03	11.71
Cefuroxime 125mg/5ml oral suspension : 5
Simvastatin and ezetimibe☰	41	Lipid-regulating drugs	6076	0.01	0.00	0.00	10.36
Simvastatin 20mg / Ezetimibe 10mg tablets : 9 Inegy 10mg/40mg tablets : 9 Inegy 10mg/20mg tablets : 13 Simvastatin 40mg / Ezetimibe 10mg tablets : 10
Oestrogens conjugated☰	24	Oestrogens and Hormone Replacement Therapy	53	0.45	0.04	0.05	8.41
Premarin 0.3mg tablets : 1 Premarin 0.625mg tablets : 3 Conjugated oestrogens 625microgram tablets : 20
Cimetidine☰	1	H2-Receptor antagonists	1	1.00	0.08	0.15	6.24
Cimetidine 400mg tablets : 1
Magnesium citrate☰	4	Magnesium	4	1.00	0.07	0.21	4.47
Magnesium citrate 200mg tablets : 4

Prescribing where Saltley And Fernbank Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Famotidine☰	0	H2-Receptor antagonists	1	0.00	0.78	0.23	-3.34
Water for injection☰	0	Electrolytes and water	10	0.00	0.82	0.26	-3.14
Cefalexin☰	10	Cephalosporins	15	0.67	0.96	0.10	-2.86
Cefalexin 250mg capsules : 1 Cefalexin 500mg capsules : 1 Cefalexin 125mg/5ml oral suspension : 1 Cefalexin 250mg/5ml oral suspension : 1 Cefalexin 250mg/5ml oral suspension sugar free : 1 Cefalexin 500mg tablets : 5
Estradiol with progestogen☰	4	Oestrogens and Hormone Replacement Therapy	53	0.08	0.39	0.12	-2.62
Evorel Conti patches : 1 Elleste Duet 1mg tablets : 1 Elleste Duet Conti tablets : 1 Kliovance tablets : 1
Neomycin sulfate☰	19	Nasal preparations for infection	41	0.46	0.84	0.14	-2.62
Neomycin 0.5% / Chlorhexidine hydrochloride 0.1% cream : 1 Naseptin nasal cream : 18