Static outliers for The Village 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 The Village Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Naphazoline hydrochloride	5	Other anti-inflammatory preparations	69	0.07	0.00	0.00	15.01
Murine irritation & redness relief 0.012% eye drops : 5
Nystatin	5	Antifungal preparations	38	0.13	0.00	0.01	14.95
Nystatin 100,000units/g / Chlorhexidine hydrochloride 1% crm : 5
Celecoxib	141	Non-steroidal anti-inflammatory drugs	434	0.32	0.03	0.04	8.13
Celecoxib 100mg capsules : 83 Celecoxib 200mg capsules : 58
Quinapril hydrochloride	11	Angiotensin-converting enzyme inhibitors	2014	0.01	0.00	0.00	8.12
Quinapril 40mg tablets : 3 Accupro 20mg tablets : 3 Quinapril 20mg tablets : 5
Aluminium and magnesium and oxetacaine	7	Antacids and simeticone	8	0.88	0.04	0.15	5.56
Antacid and Oxetacaine oral suspension : 7

Prescribing where The Village Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Amlodipine	795	Calcium-channel blockers	2044	0.39	0.75	0.11	-3.22
Amlodipine 5mg tablets : 463 Amlodipine 10mg tablets : 315 Amlodipine 2.5mg tablets : 17
Zinc oxide	0	Soothing haemorrhoidal preparations	2	0.00	0.77	0.27	-2.89

Senna	93	Stimulant laxatives	478	0.19	0.55	0.14	-2.57
Senna 7.5mg tablets : 84 Senna 15mg tablets : 4 Senna 7.5mg/5ml oral solution sugar free : 5
Citalopram hydrobromide	249	Selective serotonin re-uptake inhibitors	1924	0.13	0.32	0.08	-2.27
Citalopram 20mg tablets : 131 Citalopram 10mg tablets : 78 Citalopram 40mg tablets : 40
Hydroxychloroquine sulfate	12	Rheumatic disease suppressant drugs	221	0.05	0.37	0.16	-2.03
Hydroxychloroquine 200mg tablets : 12