Static outliers for Sina Health 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 Sina Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Olmesartan medoxomil/amlodipine/hydrochlorothiazide☰	36	Angiotensin-II receptor antagonists	564	0.06	0.00	0.00	22.16
Sevikar HCT 40mg/10mg/25mg tablets : 2 Sevikar HCT 20mg/5mg/12.5mg tablets : 14 Sevikar HCT 40mg/5mg/12.5mg tablets : 7 Sevikar HCT 40mg/5mg/25mg tablets : 7 Sevikar HCT 40mg/10mg/12.5mg tablets : 6
Apomorphine hydrochloride☰	22	Dopaminergic drugs used in parkinsonism	160	0.14	0.00	0.01	15.19
APO-go PFS 50mg/10ml inf pre-filled syringes : 4 APO-go PEN 30mg/3ml solution for injection : 18
Apomorphine hydrochloride hemihydrate☰	3	Dopaminergic drugs used in parkinsonism	160	0.02	0.00	0.00	12.52
Dacepton 100mg/20ml solution for infusion vials : 3
Ins degludec/liraglutide☰	28	Other antidiabetic drugs	572	0.05	0.00	0.01	8.97
Xultophy 100units/ml / 3.6mg/ml inj 3ml pre-filled pens : 28
Gentamicin sulfate☰	33	Antibacterials	79	0.42	0.03	0.06	6.66
Gentamicin 0.3% ear/eye drops : 33

Prescribing where Sina Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Tamsulosin hydrochloride☰	224	Drugs for urinary retention	297	0.75	0.92	0.06	-2.70
Tamsulosin 400microgram modified-release capsules : 211 Pamsvax XL 400microgram capsules (Actavis) : 2 Tamsulosin 400microgram modified-release tablets : 11
Chloramphenicol☰	36	Antibacterials	79	0.46	0.78	0.13	-2.50
Chloramphenicol 0.5% eye drops : 35 Chloramphenicol 1% eye ointment : 1
Naproxen☰	256	Non-steroidal anti-inflammatory drugs	589	0.43	0.69	0.10	-2.50
Naproxen 250mg tablets : 150 Naproxen 500mg tablets : 75 Naproxen 250mg gastro-resistant tablets : 7 Naproxen 500mg gastro-resistant tablets : 24
Amlodipine☰	612	Calcium-channel blockers	1299	0.47	0.75	0.11	-2.50
Amlodipine 5mg tablets : 481 Amlodipine 10mg tablets : 123 Amlodipine 5mg/5ml oral solution sugar free : 2 Istin 5mg tablets : 2 Amlodipine 10mg/5ml oral solution sugar free : 1 Amlodipine 5mg/5ml oral suspension sugar free : 3
Urea hydrogen peroxide☰	0	Removal of ear wax and other substances	2	0.00	0.83	0.34	-2.47