Static outliers for Lostock 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 Lostock Medical Centre is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nystatin☰	21	Antifungal preparations	97	0.22	0.00	0.01	24.71
Nystatin 100,000units/g / Chlorhexidine hydrochloride 1% crm : 21
Diclofenac potassium☰	22	Non-steroidal anti-inflammatory drugs	612	0.04	0.00	0.00	9.42
Diclofenac potassium 50mg tablets : 22
Esomeprazole☰	1246	Proton pump inhibitors	6487	0.19	0.03	0.02	7.06
Esomeprazole 20mg gastro-resistant tablets : 100 Esomeprazole 40mg gastro-resistant tablets : 1037 Esomeprazole 40mg gastro-resistant capsules : 104 Esomeprazole 20mg gastro-resistant capsules : 5
Duloxetine hydrochloride☰	206	Drugs for urinary frequency enuresis and incontinence	1047	0.20	0.04	0.04	3.99
Duloxetine 40mg gastro-resistant capsules : 196 Duloxetine 20mg gastro-resistant capsules : 10
Oestrogens conjugated☰	69	Oestrogens and Hormone Replacement Therapy	299	0.23	0.04	0.05	3.84
Premarin 0.625mg tablets : 35 Conjugated oestrogens 1.25mg tablets : 2 Premarin 1.25mg tablets : 4 Premarin 0.3mg tablets : 7 Conjugated oestrogens 625microgram tablets : 21

Prescribing where Lostock Medical Centre is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Trimethoprim☰	35	Sulfonamides and trimethoprim	68	0.51	0.86	0.13	-2.70
Trimethoprim 50mg/5ml oral suspension sugar free : 9 Trimethoprim 100mg tablets : 6 Trimethoprim 200mg tablets : 20
Pizotifen malate☰	2	Prophylaxis of migraine	75	0.03	0.65	0.26	-2.39
Pizotifen 1.5mg tablets : 2
Codeine phosphate☰	0	Cough suppressants	9	0.00	0.76	0.35	-2.18
Losartan potassium☰	177	Angiotensin-II receptor antagonists	1617	0.11	0.50	0.19	-2.09
Losartan 25mg tablets : 56 Losartan 50mg tablets : 44 Losartan 100mg tablets : 76 Losartan 12.5mg tablets : 1
Nicorandil☰	26	Other antianginal drugs	321	0.08	0.51	0.20	-2.09
Nicorandil 10mg tablets : 26