Static outliers for Fairmore Medical 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 Fairmore Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Tetracaine	28	Local anaesthetics	60	0.47	0.02	0.06	6.91
Tetracaine 4% gel : 2 Ametop 4% gel : 26
Felbinac	1	Rubefacients, topical NSAIDS, capsaicin and poultice	154	0.01	0.00	0.00	6.16
Felbinac 3% gel : 1
Magnesium oxide	22	Antacids and simeticone	22	1.00	0.05	0.19	5.07
Magnesium oxide 160mg tablets : 22
Testosterone esters	8	Male sex hormones and antagonists	62	0.13	0.01	0.02	4.86
Sustanon 250mg/1ml solution for injection ampoules : 8
Fusidic acid	19	Antibacterials	37	0.51	0.09	0.09	4.69
Fusidic acid 1% modified-release eye drops : 19

Prescribing where Fairmore Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score
Carbimazole	8	Antithyroid drugs	14	0.57	0.93	0.11	-3.39
Carbimazole 15mg tablets : 2 Carbimazole 20mg tablets : 1 Carbimazole 10mg tablets : 1 Carbimazole 5mg tablets : 4
Lidocaine hydrochloride	32	Local anaesthetics	60	0.53	0.91	0.14	-2.69
Lidocaine 20mg/2ml (1%) solution for injection ampoules : 1 Emla 5% cream : 9 Lidocaine 5% medicated plasters : 22
Chloramphenicol	17	Antibacterials	37	0.46	0.78	0.13	-2.48
Chloramphenicol 0.5% eye drops : 11 Chloramphenicol 1% eye ointment : 6
Allopurinol	129	Gout and cytotoxic induced hyperiuicaemia	167	0.77	0.89	0.05	-2.29
Allopurinol 100mg tablets : 97 Allopurinol 300mg tablets : 32
Brinzolamide	1	Treatment of glaucoma	210	0.00	0.09	0.04	-2.26
Brinzolamide 10mg/ml eye drops : 1