Static outliers for The Neville Family 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 The Neville Family 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	33	0.03	0.00	0.00	38.85
Otocomb Otic ear ointment : 1
Gluten free/low protein grains/flours	7	Foods for special diets	114	0.06	0.00	0.01	10.19
Mevalia low protein rice replacer : 7
Gluten free/low protein biscuits	12	Foods for special diets	114	0.11	0.00	0.01	9.35
Mevalia low protein fruit bar : 6 Mevalia low protein cookies : 6
Gluten free/low protein bread	17	Foods for special diets	114	0.15	0.01	0.02	6.80
Mevalia low protein pan carre : 4 Mevalia low protein pan rustico : 4 Mevalia low protein mini baguette : 4 Mevalia low protein pizza base : 5
Buspirone hydrochloride	95	Anxiolytics	277	0.34	0.03	0.06	4.88
Buspirone 5mg tablets : 69 Buspirone 10mg tablets : 26

Prescribing where The Neville Family Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Folic acid	98	Drugs used in megaloblastic anaemias	313	0.31	0.70	0.16	-2.43
Folic acid 5mg tablets : 83 Folic acid 5mg/5ml oral solution sugar free : 2 Folic acid 2.5mg/5ml oral solution sugar free : 9 Folic acid 400microgram tablets : 4
Vitamin A	0	Vitamin A	5	0.00	0.84	0.35	-2.42

Brinzolamide	0	Treatment of glaucoma	195	0.00	0.09	0.04	-2.38

Simvastatin	139	Lipid-regulating drugs	2418	0.06	0.22	0.08	-2.17
Simvastatin 20mg tablets : 38 Simvastatin 40mg tablets : 79 Simvastatin 80mg tablets : 7 Simvastatin 10mg tablets : 15
Bisoprolol fumarate	582	Beta-adrenoceptor blocking drugs	1209	0.48	0.65	0.08	-2.12
Bisoprolol 5mg tablets : 157 Bisoprolol 10mg tablets : 58 Bisoprolol 2.5mg tablets : 161 Bisoprolol 1.25mg tablets : 163 Bisoprolol 3.75mg tablets : 23 Bisoprolol 7.5mg tablets : 20