Static outliers for Cheadle Medical Practice

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 Cheadle Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Naphazoline hydrochloride☰	5	Other anti-inflammatory preparations	164	0.03	0.00	0.00	6.25
Naphazoline 0.012% eye drops : 5
Darifenacin hydrobromide☰	133	Drugs for urinary frequency enuresis and incontinence	726	0.18	0.01	0.04	4.65
Darifenacin 7.5mg modified-release tablets : 89 Darifenacin 15mg modified-release tablets : 44
Hydrocortisone sodium succinate☰	7	Use of corticosteroids	548	0.01	0.00	0.00	4.10
Hydrocortisone sodium succinate 100mg inj vials : 1 Solu-Cortef 100mg powder for solution for injection vials : 6
Promazine hydrochloride☰	126	Antipsychotic drugs	874	0.14	0.01	0.04	3.56
Promazine 25mg/5ml oral solution : 83 Promazine 50mg/5ml oral solution : 35 Promazine 25mg tablets : 8
Pravastatin sodium☰	505	Lipid-regulating drugs	5880	0.09	0.03	0.02	3.41
Pravastatin 10mg tablets : 79 Pravastatin 20mg tablets : 180 Pravastatin 40mg tablets : 246

Prescribing where Cheadle Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Mupirocin☰	0	Antibacterial preparations only used topically	4	0.00	0.64	0.37	-1.72
Gentamicin sulfate☰	0	Aminoglycosides	3	0.00	0.72	0.44	-1.65
Atorvastatin☰	3181	Lipid-regulating drugs	5880	0.54	0.66	0.08	-1.48
Atorvastatin 10mg tablets : 341 Atorvastatin 20mg tablets : 1415 Atorvastatin 40mg tablets : 957 Atorvastatin 80mg tablets : 466 Lipitor 20mg tablets : 2
Timolol and bimatoprost☰	24	Treatment of glaucoma	759	0.03	0.10	0.05	-1.32
Bimatoprost 300micrograms/ml / Timolol 5mg/ml eye drops : 14 Bimatoprost 300microg/Timolol 5mg/ml eye dps 0.4ml : 4 Ganfort 0.3mg/ml / 5mg/ml eye drops : 6
Solifenacin☰	128	Drugs for urinary frequency enuresis and incontinence	726	0.18	0.33	0.12	-1.32
Solifenacin 5mg tablets : 97 Solifenacin 10mg tablets : 31