Static outliers for Kirkham Health 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 Kirkham Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Meningococcal B vaccine☰	3	Vaccines and antisera	36	0.08	0.00	0.01	9.61
Bexsero vacc inj 0.5ml pre-filled syringes : 3
Valsartan☰	304	Angiotensin-II receptor antagonists	2835	0.11	0.02	0.02	4.66
Valsartan 40mg capsules : 31 Valsartan 80mg capsules : 127 Valsartan 160mg capsules : 146
Haemophilus influenzae B/meningococcal C☰	2	Vaccines and antisera	36	0.06	0.00	0.01	4.37
Hib/Meningococcal C conj vacc inj 0.5ml vials : 2
Humpapvirus(Type 6,11,16,18,31,33,45,52,58)☰	1	Vaccines and antisera	36	0.03	0.00	0.01	4.13
Gardasil 9 vacc inj 0.5ml pre-filled syringes : 1
Nadolol☰	17	Beta-adrenoceptor blocking drugs	4198	0.00	0.00	0.00	3.82
Nadolol 80mg tablets : 17

Prescribing where Kirkham Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Doxazosin mesilate☰	418	Alpha-adrenoceptor blocking drugs	449	0.93	0.99	0.02	-3.02
Doxazosin 1mg tablets : 90 Doxazosin 2mg tablets : 114 Doxazosin 4mg tablets : 144 Doxazosin 8mg modified-release tablets : 45 Doxazosin 4mg modified-release tablets : 20 Cardura XL 4mg tablets : 5
Amlodipine☰	1592	Calcium-channel blockers	3426	0.46	0.75	0.11	-2.55
Amlodipine 5mg tablets : 1015 Amlodipine 10mg tablets : 577
Prucalopride☰	0	Other drugs used in constipation	14	0.00	0.71	0.33	-2.18
Indapamide☰	96	Thiazides and related diuretics	1075	0.09	0.42	0.16	-2.10
Indapamide 2.5mg tablets : 46 Indapamide 1.5mg modified-release tablets : 46 Natrilix SR 1.5mg tablets : 4
Budesonide☰	0	Corticosteroids	1	0.00	0.70	0.34	-2.08