Static outliers for The Dicconson Group 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 The Dicconson Group Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Latanoprost and timolol☰	115	Treatment of glaucoma	486	0.24	0.03	0.03	6.96
Latanoprost 50micrograms/ml / Timolol 5mg/ml eye drops : 106 Xalacom eye drops : 9
Other zinc preparations☰	5	Zinc	5	1.00	0.03	0.15	6.31
Zinc citrate 50mg capsules : 5
Hydrocortisone sodium phosphate☰	9	Use of corticosteroids	373	0.02	0.00	0.00	5.48
Hydrocortisone sodium phosphate 100mg/1ml inj ampoules : 9
Prednisolone sodium phosphate☰	1	Corticosteroids	1	1.00	0.09	0.20	4.57
Prednisolone sodium phosphate 5mg suppositories : 1
Alimemazine tartrate☰	27	Antihistamines	1341	0.02	0.00	0.00	4.30
Alimemazine 30mg/5ml oral solution : 12 Alimemazine 10mg tablets : 15

Prescribing where The Dicconson Group Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ramipril☰	1293	Angiotensin-converting enzyme inhibitors	3947	0.33	0.69	0.17	-2.17
Ramipril 1.25mg capsules : 224 Ramipril 2.5mg capsules : 378 Ramipril 5mg capsules : 204 Ramipril 10mg capsules : 239 Ramipril 2.5mg tablets : 76 Ramipril 5mg tablets : 120 Ramipril 10mg tablets : 36 Ramipril 1.25mg tablets : 16
Budesonide☰	0	Corticosteroids	1	0.00	0.70	0.34	-2.08
Solifenacin☰	101	Drugs for urinary frequency enuresis and incontinence	939	0.11	0.33	0.12	-1.90
Solifenacin 5mg tablets : 49 Solifenacin 10mg tablets : 48 Vesicare 5mg tablets : 4
Timolol and bimatoprost☰	1	Treatment of glaucoma	486	0.00	0.10	0.05	-1.88
Bimatoprost 300micrograms/ml / Timolol 5mg/ml eye drops : 1
Zinc sulfate monohydrate☰	0	Zinc	5	0.00	0.73	0.40	-1.84