Static outliers for Rope Green 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 Rope Green Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Calcitriol☰	83	Vitamin D	2554	0.03	0.00	0.00	7.73
Calcitriol 250nanogram capsules : 79 Calcitriol 500nanogram capsules : 4
Pravastatin sodium☰	1022	Lipid-regulating drugs	8374	0.12	0.03	0.02	5.57
Pravastatin 10mg tablets : 146 Pravastatin 20mg tablets : 187 Pravastatin 40mg tablets : 689
Influenza☰	4995	Vaccines and antisera	5421	0.92	0.08	0.22	3.82
Influvac sub-unit Tetra vacc inj 0.5ml pre-filled syringes : 1450 Fluad vacc inj 0.5ml pre-filled syringes : 3540 Quadrivalent Flu/Vac/Split inj 0.5ml pfs : 5
Urine testing reagents☰	47	Diabetic diagnostic and monitoring agents	711	0.07	0.01	0.02	3.33
Ketostix testing strips : 47
Eletriptan☰	24	Treatment of acute migraine	509	0.05	0.00	0.01	2.94
Eletriptan 40mg tablets : 24

Prescribing where Rope Green Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Mercaptopurine☰	0	Antimetabolites	4	0.00	0.80	0.35	-2.31
Other food for special diet preparations☰	25	Foods for special diets	155	0.16	0.65	0.25	-1.96
Renapro powder 20g sachets : 1 Nutramigen 1 with LGG powder : 1 Neocate Junior powder unflavoured : 3 EleCare powder : 3 Instant Carobel powder : 11 Vital 1.5kcal liquid (3 flavours) : 6
Levonorgestrel☰	0	Emergency contraception	1	0.00	0.62	0.33	-1.87
Mirtazapine☰	633	Other antidepressant drugs	1582	0.40	0.57	0.11	-1.57
Mirtazapine 30mg tablets : 216 Mirtazapine 30mg orodispersible tablets : 29 Mirtazapine 15mg tablets : 227 Mirtazapine 45mg tablets : 129 Mirtazapine 15mg orodispersible tablets : 26 Mirtazapine 45mg orodispersible tablets : 6
Aspirin☰	1689	Antiplatelet drugs	3023	0.56	0.65	0.06	-1.55
Aspirin 75mg dispersible tablets : 1316 Aspirin 75mg tablets : 177 Aspirin 75mg gastro-resistant tablets : 196