Static outliers for Dr Kk Chan & Partners

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 Dr Kk Chan & Partners is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Sucralfate☰	1	Soothing haemorrhoidal preparations	2	0.50	0.00	0.02	26.32
Sucralfate 2g/20ml enema : 1
Low protein cakes☰	15	Foods for special diets	159	0.09	0.00	0.01	17.60
Taranis low protein lemon cake : 5 Taranis low protein apricot cake : 5 Taranis low protein pear cake : 5
Saxagliptin/metformin☰	35	Other antidiabetic drugs	1178	0.03	0.00	0.00	9.29
Saxagliptin 2.5mg / Metformin 1g tablets : 20 Saxagliptin 2.5mg / Metformin 850mg tablets : 15
Low protein biscuits☰	14	Foods for special diets	159	0.09	0.00	0.02	5.16
Loprofin low protein herb crackers : 4 Taranis low protein chocolate chip cookies : 5 Taranis low protein chocolate chip biscuits : 5
Ethambutol hydrochloride☰	4	Antituberculosis drugs	4	1.00	0.06	0.18	5.14
Ethambutol 400mg tablets : 4

Prescribing where Dr Kk Chan & Partners is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Desmopressin acetate☰	25	Posterior pituitary hormones and antagonists	26	0.96	1.00	0.01	-4.57
Desmopressin 100microgram tablets : 4 DesmoMelt 240microgram oral lyophilisates : 4 DesmoMelt 120microgram oral lyophilisates : 3 Desmopressin 200microgram tablets : 7 Desmopressin 120microgram oral lyophilisates sugar free : 7
Hydralazine hydrochloride☰	0	Vasodilator antihypertensive drugs	4	0.00	0.85	0.28	-3.01
Ispaghula husk☰	76	Bulk-forming laxatives	95	0.80	0.96	0.07	-2.19
Ispaghula husk 3.5g efferv gran sach gluten free sugar free : 46 Fybogel Hi-Fibre Orange 3.5g effervescent granules sachets : 2 Fybogel Lemon 3.5g effervescent granules sachets SF : 1 Fybogel Orange 3.5g effervescent granules sachets SF : 27
Zopiclone☰	172	Hypnotics	527	0.33	0.60	0.14	-1.98
Zopiclone 7.5mg tablets : 55 Zopiclone 3.75mg tablets : 112 Zimovane LS 3.75mg tablets : 5
Zinc sulfate monohydrate☰	0	Zinc	2	0.00	0.73	0.40	-1.84