Static outliers for Newton Heath 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 Newton Heath Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Other otitis external preparations	1	Otitis externa	26	0.04	0.0	0.00	49.32
Otocomb Otic ear ointment : 1
Cyproheptadine hydrochloride	21	Antihistamines	632	0.03	0.0	0.00	31.13
Cyproheptadine 4mg tablets : 21
Low protein meals	21	Foods for special diets	140	0.15	0.0	0.01	18.44
Promin low protein potato pot with croutons sausage : 3 Promin low protein pasta in sauce 72g sach : 6 Promin low protein pasta spirals in Moroccan type sauce 72g : 6 Promin low protein pasta in sauce 66g sach cheese & broccoli : 6
Low protein cakes	10	Foods for special diets	140	0.07	0.0	0.01	13.29
Taranis low protein lemon cake : 5 Taranis low protein apricot cake : 5
Low protein snacks	4	Foods for special diets	140	0.03	0.0	0.00	11.48
Promin low protein Snax ready salted 25g sachets : 2 Promin low protein Snax salt & vinegar 25g sachets : 2

Prescribing where Newton Heath Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Amitriptyline hydrochloride	502	Tricyclic and related antidepressant drugs	754	0.67	0.84	0.08	-2.28
Amitriptyline 10mg tablets : 295 Amitriptyline 25mg tablets : 61 Amitriptyline 50mg tablets : 141 Amitriptyline 25mg/5ml oral solution sugar free : 5
Citalopram hydrobromide	369	Selective serotonin re-uptake inhibitors	2478	0.15	0.32	0.08	-2.04
Citalopram 20mg tablets : 183 Citalopram 10mg tablets : 44 Citalopram 40mg tablets : 142
Finasteride	184	Male sex hormones and antagonists	314	0.59	0.82	0.12	-2.02
Finasteride 5mg tablets : 184
Bendroflumethiazide	149	Thiazides and related diuretics	573	0.26	0.58	0.16	-2.00
Bendroflumethiazide 2.5mg tablets : 147 Bendroflumethiazide 5mg tablets : 2
Levonorgestrel	0	Emergency contraception	1	0.00	0.62	0.33	-1.87