Static outliers for Phoenix 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 Phoenix Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Chlohexidine gluconate (Emollient)☰	5	Emollients	164	0.03	0.00	0.00	16.81
Eczmol 1% cream : 5
Dexpanthenol☰	14	Emollients	164	0.09	0.00	0.01	13.65
Bepanthen Nappy Care 5% ointment : 14
Sulindac☰	4	Non-steroidal anti-inflammatory drugs	492	0.01	0.00	0.00	9.00
Sulindac 100mg tablets : 4
Testosterone enantate☰	5	Male sex hormones and antagonists	105	0.05	0.00	0.01	7.16
Testosterone enantate 250mg/1ml inj ampoules : 5
Insulin glulisine☰	50	Short-acting insulins	126	0.40	0.03	0.05	6.73
Apidra 100units/ml inj 3ml pre-filled SoloStar pens : 45 Apidra 100units/ml solution for injection 3ml cartridges : 5

Prescribing where Phoenix Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Baclofen☰	12	Skeletal muscle relaxants	349	0.03	0.83	0.18	-4.30
Baclofen 10mg tablets : 7 Baclofen 5mg/5ml oral solution sugar free : 5
Other multivitamin preparations☰	19	Multivitamin preparations	114	0.17	0.81	0.21	-3.09
Vitasorb Multivitamins liquid : 1 Dalivit oral drops : 4 Abidec Multivitamin drops : 4 Valupak Multivitamin One A Day tablets : 5 Renavit tablets : 5
Insulin aspart☰	59	Short-acting insulins	126	0.47	0.79	0.12	-2.76
Insulin aspart 100units/ml inj 3ml pf dispos dev : 2 NovoRapid 100units/ml solution for injection 10ml vials : 13 NovoRapid FlexPen 100units/ml inj 3ml pre-filled pens : 22 NovoRapid Penfill 100units/ml inj 3ml cartridges : 16 Insulin aspart 100units/ml inj 3ml cartridges : 6
Midazolam hydrochloride☰	0	Drugs used in status epilepticus	1	0.00	0.79	0.30	-2.62
Vitamin A☰	0	Vitamin A	8	0.00	0.84	0.35	-2.42