Static outliers for Marine Lake Medical Practice

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 Marine Lake Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Dequalinium chloride☰	5	Vaginal and vulval infections	121	0.04	0.0	0.01	7.15
Fluomizin 10mg vaginal tablets : 5
Tenoxicam☰	3	Non-steroidal anti-inflammatory drugs	1346	0.00	0.0	0.00	6.98
Tenoxicam 20mg tablets : 3
Clemastine fumarate☰	5	Antihistamines	1474	0.00	0.0	0.00	6.70
Clemastine 1mg tablets : 5
Levothyroxine sodium and liothyronine☰	12	Thyroid hormones	4854	0.00	0.0	0.00	5.81
Armour Thyroid 60mg (1 grain) tablets : 2 Erfa Thyroid 60mg (1 grain) tablets : 5 Erfa Thyroid 30mg (half grain) tablets : 5
Ceftazidime pentahydrate☰	2	Cephalosporins	282	0.01	0.0	0.00	5.64
Ceftazidime 2g powder for solution for injection vials : 2

Prescribing where Marine Lake Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Amlodipine☰	2207	Calcium-channel blockers	5933	0.37	0.75	0.11	-3.37
Amlodipine 5mg tablets : 1295 Amlodipine 10mg tablets : 880 Amlodipine 2.5mg tablets : 14 Istin 5mg tablets : 18
Hydralazine hydrochloride☰	0	Vasodilator antihypertensive drugs	3	0.00	0.85	0.28	-3.01
Water for injection☰	7	Electrolytes and water	62	0.11	0.82	0.26	-2.71
Water for injections 20ml ampoules : 2 Water for injections 5ml ampoules : 1 Water for injections 100ml vials : 1 Water for injections 10ml ampoules : 3
Aspirin☰	1918	Antiplatelet drugs	3563	0.54	0.65	0.06	-1.88
Aspirin 75mg dispersible tablets : 1616 Aspirin 75mg tablets : 117 Aspirin 75mg gastro-resistant tablets : 183 Nu-Seals 75 gastro-resistant tablets : 2
Hydroxychloroquine sulfate☰	35	Rheumatic disease suppressant drugs	441	0.08	0.37	0.16	-1.86
Hydroxychloroquine 200mg tablets : 35