Static outliers for Barrowford 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 Barrowford Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Methylcellulose☰	2	Bulk-forming laxatives	19	0.11	0.00	0.01	15.07
Methylcellulose 500mg tablets : 2
Sodium clodronate☰	6	Bisphosphonates and other drugs	102	0.06	0.00	0.01	11.38
Sodium clodronate 800mg tablets : 6
Escitalopram☰	312	Selective serotonin re-uptake inhibitors	887	0.35	0.04	0.04	8.82
Escitalopram 10mg tablets : 141 Escitalopram 20mg tablets : 138 Escitalopram 5mg tablets : 33
Formoterol fumarate☰	28	Selective beta(2)-agonists	476	0.06	0.00	0.01	8.30
Formoterol 12micrograms/dose dry powder inhaler : 18 Formoterol Easyhaler 12micrograms/dose dry powder inhaler : 10
Urea☰	49	Emollients	87	0.56	0.09	0.06	7.79
Balneum Plus cream : 34 Urea 10% lotion : 2 Eucerin Dry Skin Relief 5% cream : 3 E45 Itch Relief cream : 10

Prescribing where Barrowford Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Other emollient preparations☰	38	Emollients	87	0.44	0.89	0.07	-6.47
Diprobase ointment : 1 Aveeno cream : 4 Aveeno moisturising creamy oil : 4 Dermol cream : 3 Doublebase Dayleve gel : 3 E45 cream : 7 Doublebase gel : 11 Dermol 500 lotion : 5
Allopurinol☰	93	Gout and cytotoxic induced hyperiuicaemia	161	0.58	0.89	0.05	-5.94
Allopurinol 100mg tablets : 45 Allopurinol 300mg tablets : 48
Benzydamine hydrochloride☰	0	Drugs for oral ulceration and inflammation	2	0.00	0.83	0.18	-4.47
Tamsulosin hydrochloride☰	155	Drugs for urinary retention	214	0.72	0.92	0.06	-3.19
Tamsulosin 400microgram modified-release capsules : 143 Tamsulosin 400microgram modified-release tablets : 12
Clotrimazole☰	10	Vaginal and vulval infections	15	0.67	0.90	0.10	-2.43
Clotrimazole 500mg pessaries : 2 Clotrimazole 500mg pessary and Clotrimazole 2% cream : 1 Fluconazole 150mg capsule and Clotrimazole 2% cream : 1 Canesten Combi 500mg pessary and 2% cream : 1 Clotrimazole 2% cream : 5