Static outliers for Tonge Fold 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 Tonge Fold Health Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Levomepromazine maleate☰	48	Antipsychotic drugs	814	0.06	0.00	0.01	7.54
Levomepromazine 25mg tablets : 48
Promazine hydrochloride☰	237	Antipsychotic drugs	814	0.29	0.01	0.04	7.46
Promazine 25mg/5ml oral solution : 207 Promazine 25mg tablets : 4 Promazine 50mg/5ml oral solution : 26
Magnesium trisilicate☰	2	Antacids and simeticone	2	1.00	0.03	0.14	7.11
Magnesium trisilicate oral suspension : 2
Torasemide☰	20	Loop diuretics	585	0.03	0.00	0.00	6.91
Torasemide 10mg tablets : 3 Torasemide 2.5mg tablets : 6 Torem 5mg tablets : 6 Torasemide 5mg tablets : 5
Loteprednol etabonate☰	2	Corticosteroids	6	0.33	0.02	0.05	5.70
Lotemax 0.5% eye drops : 2

Prescribing where Tonge Fold Health Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Amitriptyline hydrochloride☰	389	Tricyclic and related antidepressant drugs	634	0.61	0.84	0.08	-2.96
Amitriptyline 10mg tablets : 318 Amitriptyline 25mg tablets : 44 Amitriptyline 50mg tablets : 27
Furosemide☰	349	Loop diuretics	585	0.60	0.86	0.09	-2.90
Furosemide 20mg tablets : 151 Furosemide 40mg tablets : 198
Isosorbide mononitrate☰	81	Nitrates	186	0.44	0.73	0.11	-2.75
Chemydur 60XL tablets : 60 Isosorbide mononitrate 40mg modified-release tablets : 2 Isosorbide mononitrate 60mg modified-release tablets : 8 Monomil XL 60mg tablets : 6 Isosorbide mononitrate 25mg modified-release capsules : 5
Quinine sulfate☰	44	Antimalarials	81	0.54	0.89	0.14	-2.47
Quinine sulfate 200mg tablets : 22 Quinine sulfate 300mg tablets : 22
Mebeverine hydrochloride☰	24	Antispasmodic and other drugs altering gut motility	171	0.14	0.45	0.13	-2.44
Mebeverine 200mg modified-release capsules : 5 Mebeverine 135mg tablets : 19