Static outliers for St Ann'S Road Surgery

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 St Ann'S Road Surgery is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Granisetron hydrochloride☰	4	Drugs used in nausea and vertigo	495	0.01	0.00	0.00	12.63
Granisetron 1mg tablets : 4
Alendronic acid/colecalciferol☰	9	Bisphosphonates and other drugs	203	0.04	0.00	0.01	8.30
Alendronic acid 70mg / Colecalciferol 70microgram tablets : 9
Amiloride hydrochloride with loop diuretics☰	20	Potassium sparing diuretics and compounds	29	0.69	0.02	0.08	8.18
Amiloride 5mg / Bumetanide 1mg tablets : 20
Pyrimethamine☰	1	Antimalarials	185	0.01	0.00	0.00	6.74
Pyrimethamine 25mg tablets : 1
Belladonna alkaloids☰	11	Antispasmodic and other drugs altering gut motility	258	0.04	0.00	0.01	6.27
Belladonna medicated plaster 9.5cm x 12.5cm : 6 Belladonna medicated plaster 28cm x 17.5cm : 5

Prescribing where St Ann'S Road Surgery is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Aciclovir☰	58	Herpes simplex and varicella-zoster	79	0.73	0.95	0.07	-3.20
Aciclovir 200mg/5ml oral suspension sugar free : 1 Aciclovir 400mg dispersible tablets : 1 Aciclovir 400mg tablets : 27 Aciclovir 200mg tablets : 8 Aciclovir 800mg tablets : 21
Carbimazole☰	63	Antithyroid drugs	101	0.62	0.93	0.11	-2.90
Carbimazole 5mg tablets : 40 Carbimazole 10mg tablets : 8 Carbimazole 20mg tablets : 15
Potassium chloride☰	2	Oral potassium	3	0.67	0.98	0.12	-2.62
Sando-K effervescent tablets : 2
Famotidine☰	13	H2-Receptor antagonists	56	0.23	0.78	0.23	-2.35
Famotidine 20mg tablets : 3 Famotidine 40mg tablets : 10
Co-amilofruse (Amiloride hydrochloride/frusemide)☰	0	Potassium sparing diuretics and compounds	29	0.00	0.68	0.33	-2.07