Static outliers for Spring View 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 Spring View Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Alogliptin/metformin☰	206	Other antidiabetic drugs	849	0.24	0.00	0.02	12.98
Alogliptin 12.5mg / Metformin 1g tablets : 206
Enalapril maleate with diuretic☰	23	Angiotensin-converting enzyme inhibitors	2502	0.01	0.00	0.00	10.37
Enalapril 20mg / Hydrochlorothiazide 12.5mg tablets : 23
Promazine hydrochloride☰	218	Antipsychotic drugs	655	0.33	0.01	0.04	8.57
Promazine 25mg/5ml oral solution : 197 Promazine 50mg tablets : 6 Promazine 25mg tablets : 15
Cyproheptadine hydrochloride☰	5	Antihistamines	651	0.01	0.00	0.00	7.08
Periactin 4mg tablets : 5
Tafluprost☰	24	Treatment of glaucoma	328	0.07	0.01	0.01	6.19
Saflutan 15micrograms/ml eye drops 0.3ml unit dose : 17 Tafluprost 15micrograms/ml eye dps 0.3ml ud preserv free : 7

Prescribing where Spring View Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Water for injection☰	0	Electrolytes and water	1	0.00	0.82	0.26	-3.14
Gliclazide☰	329	Sulfonylureas	614	0.54	0.92	0.14	-2.87
Gliclazide 80mg tablets : 252 Gliclazide 40mg tablets : 56 Gliclazide 60mg modified-release tablets : 9 Gliclazide 30mg modified-release tablets : 12
Furosemide☰	302	Loop diuretics	457	0.66	0.86	0.09	-2.18
Furosemide 20mg tablets : 118 Furosemide 40mg tablets : 181 Furosemide 20mg/5ml oral solution sugar free : 3
Indapamide☰	46	Thiazides and related diuretics	525	0.09	0.42	0.16	-2.11
Indapamide 1.5mg modified-release tablets : 32 Indapamide 2.5mg tablets : 14
Solifenacin☰	33	Drugs for urinary frequency enuresis and incontinence	330	0.10	0.33	0.12	-1.97
Solifenacin 5mg tablets : 14 Solifenacin 10mg tablets : 19