Static outliers for Ashton 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 Ashton Medical Group is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Cloral betaine☰	6	Hypnotics	1403	0.00	0.00	0.00	14.81
Cloral betaine 707mg tablets : 6
Low protein cakes☰	8	Foods for special diets	274	0.03	0.00	0.01	5.34
Taranis low protein lemon cake : 4 Taranis low protein apricot cake : 4
Hydrochlorothiazide☰	6	Thiazides and related diuretics	1372	0.00	0.00	0.00	4.84
Hydrochlorothiazide 25mg tablets : 6
Promazine hydrochloride☰	391	Antipsychotic drugs	2238	0.17	0.01	0.04	4.37
Promazine 25mg/5ml oral solution : 182 Promazine 25mg tablets : 30 Promazine 50mg tablets : 37 Promazine 50mg/5ml oral solution : 142
Naphazoline hydrochloride☰	4	Other anti-inflammatory preparations	188	0.02	0.00	0.00	4.33
Murine irritation & redness relief 0.012% eye drops : 4

Prescribing where Ashton Medical Group is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Terbinafine hydrochloride☰	42	Other antifungals	47	0.89	0.99	0.03	-2.89
Terbinafine 250mg tablets : 42
Baclofen☰	119	Skeletal muscle relaxants	295	0.40	0.83	0.18	-2.30
Baclofen 5mg/5ml oral solution sugar free : 48 Baclofen 10mg tablets : 67 Baclofen 10mg/5ml oral solution sugar free : 4
Folic acid☰	703	Drugs used in megaloblastic anaemias	1965	0.36	0.70	0.16	-2.15
Folic acid 5mg tablets : 665 Folic acid 400microgram tablets : 36 Folic acid 2.5mg/5ml oral solution sugar free : 2
Methylprednisolone acetate☰	0	Local corticosteroid injections	1	0.00	0.73	0.39	-1.87
Ciprofloxacin☰	22	Quinolones	36	0.61	0.86	0.15	-1.66
Ciprofloxacin 500mg tablets : 14 Ciprofloxacin 250mg tablets : 8