Static outliers for Al Fal Medical Group

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 Al Fal Medical Group is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sodium clodronate☰	8	Bisphosphonates and other drugs	110	0.07	0.00	0.01	14.12
Sodium clodronate 800mg tablets : 8
Estradiol valandestradiol valerate with dienogest☰	2	Combined hormonal contraceptives	34	0.06	0.00	0.01	10.68
Qlaira tablets : 2
Valsartan with diuretic☰	30	Angiotensin-II receptor antagonists	517	0.06	0.00	0.01	9.81
Valsartan 160mg / Hydrochlorothiazide 25mg tablets : 13 Valsartan 80mg / Hydrochlorothiazide 12.5mg tablets : 11 Valsartan 160mg / Hydrochlorothiazide 12.5mg tablets : 6
Safinamide☰	5	Dopaminergic drugs used in parkinsonism	41	0.12	0.00	0.01	8.13
Safinamide 50mg tablets : 5
Fenofibrate☰	154	Lipid-regulating drugs	2523	0.06	0.01	0.01	7.78
Fenofibrate micronised 160mg tablets : 118 Fenofibrate micronised 67mg capsules : 21 Fenofibrate micronised 200mg capsules : 15

Prescribing where Al Fal Medical Group is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gliclazide☰	226	Sulfonylureas	715	0.32	0.92	0.14	-4.49
Gliclazide 80mg tablets : 181 Gliclazide 40mg tablets : 40 Gliclazide 160mg tablets : 5
Prednisolone☰	105	Use of corticosteroids	163	0.64	0.88	0.06	-3.74
Prednisolone 1mg tablets : 33 Prednisolone 5mg tablets : 66 Prednisolone 5mg soluble tablets : 2 Prednisolone 5mg gastro-resistant tablets : 4
Calcipotriol☰	19	Preparations for psoriasis	30	0.63	0.87	0.08	-2.88
Dovobet ointment : 3 Enstilar 50micrograms/g / 0.5 mg/g cutaneous foam : 6 Calcipotriol 50microg/Betamethasone diprop 500microg/g foam : 5 Dovobet gel : 5
Spironolactone☰	17	Potassium-sparing diuretics and aldosterone antagonists	49	0.35	0.72	0.14	-2.71
Spironolactone 25mg tablets : 12 Spironolactone 100mg tablets : 5
Estradiol with progestogen☰	1	Oestrogens and Hormone Replacement Therapy	12	0.08	0.39	0.12	-2.56
Femoston 1/10mg tablets : 1