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

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Gluten free/low protein drink	1	Foods for special diets	22	0.05	0.00	0.00	31.68
Mevalia Lattis low protein drink : 1
Typhoid	1	Vaccines and antisera	1	1.00	0.05	0.11	8.88
Typhim Vi 25micrograms/0.5ml vacc inj pre-filled syringes : 1
Gluten free/low protein biscuits	2	Foods for special diets	22	0.09	0.00	0.01	8.04
Mevalia low protein fruit bar : 2
Loperamide hydrochloride and simeticone	2	Antimotility drugs	38	0.05	0.00	0.01	5.79
Imodium Plus Comfort tablets : 2
Clindamycin phosphate	3	Vaginal and vulval infections	10	0.30	0.03	0.05	5.76
Clindamycin 2% vaginal cream : 3

Prescribing where The Euxton Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Loperamide hydrochloride	36	Antimotility drugs	38	0.95	1.00	0.01	-4.29
Loperamide 2mg capsules : 36
Combined ethinylestradiol 30mcg	83	Combined hormonal contraceptives	142	0.58	0.81	0.07	-3.04
Microgynon 30 tablets : 36 Gedarel 30microgram/150microgram tablets : 1 Yasmin tablets : 14 Ethinylestradiol 30microgram / Drospirenone 3mg tablets : 4 Levest 150/30 tablets (Morningside) : 4 Rigevidon tablets : 4 Ethinylestradiol 30microg / Levonorgestrel 150microg tab : 13 Marvelon tablets : 7
Sodium cromoglicate	2	Other anti-inflammatory preparations	15	0.13	0.67	0.18	-2.92
Sodium cromoglicate 2% eye drops : 2
Chloramphenicol	34	Antibacterials	79	0.43	0.78	0.13	-2.70
Chloramphenicol 0.5% eye drops : 13 Chloramphenicol 1% eye ointment : 21
Oral rehydration salts	0	Oral sodium and water	7	0.00	0.68	0.31	-2.20