Static outliers for Heswall & Pensby Group 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 Heswall & Pensby Group Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Ceftazidime pentahydrate	5	Cephalosporins	181	0.03	0.00	0.00	22.10
Ceftazidime 1g powder for solution for injection vials : 2 Ceftazidime 2g powder for solution for injection vials : 3
Doxycycline hyclate	4	Drugs for oral ulceration and inflammation	22	0.18	0.00	0.02	8.74
Doxycycline 20mg tablets : 4
Felodipine	3906	Calcium-channel blockers	6159	0.63	0.08	0.08	6.57
Felodipine 5mg modified-release tablets : 170 Felodipine 10mg modified-release tablets : 96 Felodipine 2.5mg modified-release tablets : 200 Cardioplen XL 5mg tablets : 1576 Cardioplen XL 10mg tablets : 837 Cardioplen XL 2.5mg tablets : 1019 Parmid XL 2.5mg tablets : 2 Plendil 10mg modified-release tablets : 3 Vascalpha 5mg modified-release tablets (Accord) : 3
Fluocinolone acetonide	81	Topical corticosteroids	1658	0.05	0.01	0.01	4.43
Fluocinolone acetonide 0.025% cream : 2 Fluocinolone acetonide 0.025% / Clioquinol 3% cream : 2 Fluocinolone acetonide 0.025% / Clioquinol 3% ointment : 4 Synalar C cream : 4 Synalar 1 in 4 Dilution 0.00625% ointment : 13 Synalar 0.025% gel : 13 Fluocinolone acetonide 0.025% ointment : 8 Synalar 0.025% cream : 3 Fluocinolone acetonide 0.00625% cream : 11 Synalar 0.025% ointment : 6 Synalar C ointment : 10 Fluocinolone acetonide 0.00625% ointment : 5
Celecoxib	234	Non-steroidal anti-inflammatory drugs	1296	0.18	0.03	0.04	4.15
Celecoxib 100mg capsules : 130 Celecoxib 200mg capsules : 104

Prescribing where Heswall & Pensby Group Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Amlodipine	1796	Calcium-channel blockers	6159	0.29	0.75	0.11	-4.08
Amlodipine 5mg tablets : 1165 Amlodipine 10mg tablets : 615 Istin 10mg tablets : 9 Amlodipine 2.5mg tablets : 7
Hydralazine hydrochloride	0	Vasodilator antihypertensive drugs	5	0.00	0.85	0.28	-3.01

Water for injection	5	Electrolytes and water	42	0.12	0.82	0.26	-2.68
Water for injections 10ml vials : 1 Water for injections 10ml ampoules : 4
Permethrin	1	Parasiticidal preparations	4	0.25	0.84	0.25	-2.34
Permethrin 5% cream : 1
Medroxyprogesterone acetate	29	Parenteral progestogen-only contraceptives	52	0.56	0.88	0.16	-1.99
Sayana Press 104mg/0.65ml inj pre-filled disposable devices : 1 Depo-Provera 150mg/1ml inj pre-filled syringes : 28