Static outliers for Stamford House

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 Stamford House is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Ephedrine hydrochloride	1	Topical nasal decongestants	1	1.00	0.01	0.06	17.74
Ephedrine 0.5% nasal drops : 1
Nystatin	6	Antifungal preparations	51	0.12	0.00	0.01	13.35
Nystatin 100,000units/g / Chlorhexidine hydrochloride 1% crm : 6
Promazine hydrochloride	157	Antipsychotic drugs	560	0.28	0.01	0.04	7.17
Promazine 25mg/5ml oral solution : 144 Promazine 25mg tablets : 2 Promazine 50mg/5ml oral solution : 11
Naratriptan hydrochloride	20	Treatment of acute migraine	72	0.28	0.04	0.05	5.09
Naratriptan 2.5mg tablets : 20
Nadolol	6	Beta-adrenoceptor blocking drugs	1279	0.00	0.00	0.00	4.48
Nadolol 80mg tablets : 6

Prescribing where Stamford House is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Trimethoprim	16	Sulfonamides and trimethoprim	30	0.53	0.86	0.13	-2.56
Trimethoprim 200mg tablets : 3 Trimethoprim 50mg/5ml oral suspension sugar free : 7 Trimethoprim 100mg tablets : 6
Folic acid	224	Drugs used in megaloblastic anaemias	665	0.34	0.70	0.16	-2.28
Folic acid 5mg tablets : 223 Folic acid 400microgram tablets : 1
Dexamethasone	0	Corticosteroids	10	0.00	0.50	0.23	-2.19

Memantine hydrochloride	0	Drugs for dementia	17	0.00	0.37	0.18	-2.09

Co-amilofruse (Amiloride hydrochloride/frusemide)	0	Potassium sparing diuretics and compounds	13	0.00	0.68	0.33	-2.07