Static outliers for Gate 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 Gate Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Bupivacaine hydrochloride☰	8	Local anaesthetics	15	0.53	0.01	0.05	11.32
Bupivacaine 25mg/10ml (0.25%) inj ampoules : 1 Marcain 0.25% inj 10ml Polyamp Steripack ampoules : 7
Analgesics with anti-emetics☰	31	Treatment of acute migraine	70	0.44	0.04	0.05	7.72
Paramax sachets : 2 Migraleve Pink tablets : 8 Migraleve tablets : 21
Solifenacin/tamsulosin☰	17	Drugs for urinary retention	165	0.10	0.01	0.02	6.40
Solifenacin 6mg / Tamsulosin 400microgram MR tab : 17
Valsartan/amlodipine☰	13	Calcium-channel blockers	994	0.01	0.00	0.00	6.16
Amlodipine 5mg / Valsartan 80mg tablets : 3 Amlodipine 10mg / Valsartan 160mg tablets : 10
Biphasic insulin lispro☰	155	Intermediate and long-acting insulins	496	0.31	0.05	0.06	4.55
Humalog Mix25 KwikPen 100units/ml inj 3ml pre-filled pens : 36 Humalog Mix50 KwikPen 100units/ml inj 3ml pre-filled pens : 107 Humalog Mix25 100units/ml inj 3ml cartridges : 6 Humalog Mix50 100units/ml inj 3ml cartridges : 6

Prescribing where Gate Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Lidocaine hydrochloride☰	6	Local anaesthetics	15	0.40	0.91	0.14	-3.65
Bonjela Junior gel : 6
Tamsulosin hydrochloride☰	126	Drugs for urinary retention	165	0.76	0.92	0.06	-2.54
Tamsulosin 400microgram modified-release capsules : 96 Tamsulosin 400microgram modified-release tablets : 8 Pamsvax XL 400microgram capsules (Actavis) : 22
Pseudoephedrine hydrochloride☰	5	Systemic nasal decongestants	10	0.50	0.96	0.18	-2.52
Pseudoephedrine 30mg/5ml oral solution : 1 Pseudoephedrine hydrochloride 60mg tablets : 1 Pseudoephedrine 30mg/5ml oral solution sugar free : 3
Fluconazole☰	1	Triazole antifungals	2	0.50	0.85	0.15	-2.39
Fluconazole 150mg capsules : 1
Estradiol☰	1	Oestrogens and Hormone Replacement Therapy	8	0.12	0.46	0.14	-2.38
Elleste Solo 2mg tablets : 1