Static outliers for Lever Chambers 2

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 Lever Chambers 2 is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Alclometasone dipropionate☰	10	Topical corticosteroids	456	0.02	0.00	0.00	209.09
Alclometasone 0.05% cream : 10
Salicylic acid☰	27	Preparations for psoriasis	60	0.45	0.00	0.01	48.78
Salicylic acid 10% in Aqueous cream : 2 Salicylic acid 2% in Generic Unguentum M cream : 15 Salicylic acid 2% ointment : 10
Amantadine hydrochloride☰	33	Dopaminergic drugs used in parkinsonism	72	0.46	0.03	0.04	10.15
Amantadine 100mg capsules : 33
Nebivolol☰	213	Beta-adrenoceptor blocking drugs	1352	0.16	0.01	0.02	8.27
Nebivolol 5mg tablets : 198 Nebivolol 10mg tablets : 9 Nebivolol 2.5mg tablets : 6
Chloramphenicol☰	1	Otitis externa	36	0.03	0.00	0.00	7.21
Chloramphenicol 10% ear drops : 1

Prescribing where Lever Chambers 2 is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Calcipotriol☰	32	Preparations for psoriasis	60	0.53	0.87	0.08	-4.09
Dovobet gel : 4 Enstilar 50micrograms/g / 0.5 mg/g cutaneous foam : 8 Dovobet ointment : 15 Calcipotriol 50micrograms/g ointment : 5
Finasteride☰	39	Male sex hormones and antagonists	82	0.48	0.82	0.12	-2.98
Finasteride 5mg tablets : 39
Ispaghula husk☰	25	Bulk-forming laxatives	33	0.76	0.96	0.07	-2.77
Ispaghula husk 3.5g efferv gran sach gluten free sugar free : 1 Fybogel 3.5g effervescent granules sachets plain SF : 1 Fybogel Lemon 3.5g effervescent granules sachets SF : 1 Fybogel Orange 3.5g effervescent granules sachets SF : 22
Gliclazide☰	322	Sulfonylureas	566	0.57	0.92	0.14	-2.62
Gliclazide 80mg tablets : 156 Gliclazide 40mg tablets : 152 Gliclazide 30mg modified-release tablets : 14
Glycopyrronium bromide☰	0	Antimuscarinic drugs	2	0.00	0.82	0.36	-2.30