Static outliers for Parkside Surgery

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 Parkside Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Hepatitis A/hepatitis B☰	19	Vaccines and antisera	32	0.59	0.01	0.05	11.48
Ambirix vacc inj 1ml pre-filled syringes : 19
Degarelix☰	27	Prostate cancer and gonadorelin analogues	88	0.31	0.03	0.07	3.93
Degarelix 80mg inj vials : 27
Acetylcysteine☰	13	Tear deficiency, eye lubricant/astringent	178	0.07	0.01	0.02	3.47
Acetylcysteine 5% eye drops : 2 Ilube 5% eye drops : 11
Low protein cooking aids☰	1	Foods for special diets	85	0.01	0.00	0.00	3.23
Mevalia low protein egg replacer : 1
Dorzolamide☰	161	Treatment of glaucoma	1343	0.12	0.04	0.03	2.91
Dorzolamide 20mg/ml eye drops : 148 Trusopt 20mg/ml eye drops : 2 Dorzolamide 20mg/ml eye drops 0.2ml unit dose preserv free : 11

Prescribing where Parkside Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Oral rehydration salts☰	3	Oral sodium and water	16	0.19	0.68	0.31	-1.60
Dioralyte Relief oral powder sachets blackcurrant : 2 Dioralyte oral powder sachets citrus : 1
Bimatoprost☰	23	Treatment of glaucoma	1343	0.02	0.11	0.06	-1.58
Lumigan 100micrograms/ml eye drops : 4 Bimatoprost 100micrograms/ml eye drops : 19
Nicotine☰	1	Nicotine dependence	35	0.03	0.55	0.34	-1.54
Nicotine 25mg/16hours transdermal patches : 1
Rosuvastatin calcium☰	25	Lipid-regulating drugs	8218	0.00	0.04	0.02	-1.53
Rosuvastatin 5mg tablets : 12 Rosuvastatin 10mg tablets : 7 Rosuvastatin 20mg tablets : 6
Apixaban☰	392	Oral anticoagulants	2139	0.18	0.40	0.14	-1.53
Apixaban 2.5mg tablets : 106 Apixaban 5mg tablets : 286