Static outliers for Stonehill 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 Stonehill Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Triamterene with loop diuretics☰	3	Potassium sparing diuretics and compounds	5	0.60	0.01	0.07	8.28
Triamterene 50mg / Furosemide 40mg tablets : 3
Fondaparinux sodium☰	5	Parenteral anticoagulants	19	0.26	0.00	0.03	7.50
Fondaparinux sodium 7.5mg/0.6ml inj pre-filled syringes : 5
Promazine hydrochloride☰	789	Antipsychotic drugs	3354	0.24	0.01	0.04	5.97
Promazine 25mg/5ml oral solution : 701 Promazine 25mg tablets : 40 Promazine 50mg/5ml oral solution : 42 Promazine 50mg tablets : 6
Xipamide☰	7	Thiazides and related diuretics	1060	0.01	0.00	0.00	5.09
Xipamide 20mg tablets : 7
Pioglitazone hydrochloride☰	522	Other antidiabetic drugs	1848	0.28	0.05	0.05	4.51
Pioglitazone 15mg tablets : 140 Pioglitazone 30mg tablets : 133 Pioglitazone 45mg tablets : 249

Prescribing where Stonehill Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Tramadol hydrochloride☰	86	Opioid analgesics	2040	0.04	0.27	0.09	-2.48
Tramadol 50mg capsules : 76 Tramadol 50mg modified-release tablets : 1 Marol 150mg modified-release tablets (Teva) : 1 Marol 100mg modified-release tablets (Teva) : 3 Marol 200mg modified-release tablets (Teva) : 5
Bisoprolol fumarate☰	2056	Beta-adrenoceptor blocking drugs	4516	0.46	0.65	0.08	-2.45
Bisoprolol 5mg tablets : 324 Bisoprolol 10mg tablets : 168 Bisoprolol 2.5mg tablets : 826 Bisoprolol 3.75mg tablets : 140 Bisoprolol 7.5mg tablets : 79 Bisoprolol 1.25mg tablets : 519
Fluconazole☰	24	Triazole antifungals	47	0.51	0.85	0.15	-2.31
Fluconazole 50mg/5ml oral suspension : 1 Fluconazole 150mg capsules : 18 Fluconazole 50mg capsules : 5
Glycopyrronium bromide☰	0	Antimuscarinic drugs	14	0.00	0.82	0.36	-2.30
Co-amilofruse (Amiloride hydrochloride/frusemide)☰	0	Potassium sparing diuretics and compounds	5	0.00	0.68	0.33	-2.07