Static outliers for Solihull Healthcare Partnership

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 Solihull Healthcare Partnership is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Rivastigmine☰	50	Drugs for dementia	55	0.91	0.10	0.10	7.91
Rivastigmine 2mg/ml oral solution sugar free : 2 Rivastigmine 4.6mg/24hours transdermal patches : 3 Rivastigmine 3mg capsules : 16 Rivastigmine 4.5mg capsules : 24 Rivastigmine 9.5mg/24hours transdermal patches : 5
Low protein snacks☰	10	Foods for special diets	756	0.01	0.00	0.00	5.25
Promin low protein Snax salt & vinegar 25g sachets : 4 Promin low protein Snax cheese & onion 25g sachets : 3 Promin low protein Snax jalapeno 25g sachets : 3
Tenoxicam☰	3	Non-steroidal anti-inflammatory drugs	2214	0.00	0.00	0.00	4.22
Tenoxicam 20mg tablets : 3
Mepivacaine hydrochloride☰	17	Local anaesthetics	500	0.03	0.00	0.01	2.79
Scandonest plain 3% solution for injection 2.2ml cartridges : 17
Levomepromazine hydrochloride☰	93	Antipsychotic drugs	1938	0.05	0.01	0.02	2.43
Levomepromazine 25mg/1ml solution for injection ampoules : 93

Prescribing where Solihull Healthcare Partnership is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Donepezil hydrochloride☰	4	Drugs for dementia	55	0.07	0.49	0.19	-2.26
Donepezil 5mg tablets : 4
Warfarin sodium☰	14	Oral anticoagulants	6053	0.00	0.24	0.11	-2.17
Warfarin 5mg tablets : 4 Warfarin 1mg tablets : 5 Warfarin 3mg tablets : 5
Memantine hydrochloride☰	1	Drugs for dementia	55	0.02	0.37	0.18	-1.99
Memantine 10mg/ml oral solution sugar free : 1
Methylprednisolone acetate☰	57	Local corticosteroid injections	358	0.16	0.73	0.39	-1.46
Depo-Medrone 40mg/1ml suspension for injection vials : 40 Depo-Medrone 80mg/2ml suspension for injection vials : 2 Methylprednisolone acetate 40mg/1ml inj vials : 4 Depo-Medrone with Lidocaine inj 2ml vials : 6 Methylprednisolone acetate 120mg/3ml inj vials : 5
Medroxyprogesterone acetate☰	0	Progestogens	4	0.00	0.65	0.46	-1.42