Static outliers for Royal Primary Care East

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 Royal Primary Care East is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Ciprofloxacin/fluocinolone☰	11	Otitis externa	211	0.05	0.00	0.01	6.45
Cetraxal Plus 3mg/ml + 0.25mg/ml ear drops 0.25ml unit dose : 11
Almotriptan☰	73	Treatment of acute migraine	623	0.12	0.01	0.02	4.48
Almotriptan 12.5mg tablets : 73
Hydrogen peroxide☰	6	Oxidisers and dyes	6	1.00	0.06	0.22	4.25
Hydrogen peroxide 3% solution : 6
Hepatitis A/hepatitis B☰	5	Vaccines and antisera	27	0.19	0.01	0.05	3.42
Twinrix Adult vacc inj 1ml pre-filled syringes : 5
Formoterol fumarate☰	160	Selective beta(2)-agonists	6051	0.03	0.00	0.01	3.39
Formoterol 12micrograms/dose inhaler CFC free : 80 Atimos Modulite 12micrograms/dose inhaler : 32 Formoterol Easyhaler 12micrograms/dose dry powder inhaler : 40 Oxis 6 Turbohaler : 2 Formoterol 6micrograms/dose dry powder inhaler : 1 Formoterol 12microgram inhalation pdr caps with device : 5

Prescribing where Royal Primary Care East is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Potassium permanganate☰	0	Oxidisers and dyes	6	0.00	0.94	0.22	-4.21
Cefalexin☰	40	Cephalosporins	58	0.69	0.96	0.10	-2.64
Cefalexin 250mg capsules : 2 Cefalexin 250mg/5ml oral suspension : 1 Cefalexin 250mg tablets : 14 Cefalexin 500mg capsules : 23
Acamprosate calcium☰	10	Alcohol dependence	49	0.20	0.83	0.31	-2.03
Acamprosate 333mg gastro-resistant tablets : 10
Indapamide☰	351	Thiazides and related diuretics	2884	0.12	0.42	0.16	-1.89
Indapamide 2.5mg tablets : 283 Indapamide 1.5mg modified-release tablets : 68
Bisoprolol fumarate☰	4197	Beta-adrenoceptor blocking drugs	8319	0.50	0.65	0.08	-1.83
Bisoprolol 5mg tablets : 918 Bisoprolol 10mg tablets : 325 Bisoprolol 2.5mg tablets : 1570 Bisoprolol 3.75mg tablets : 165 Bisoprolol 7.5mg tablets : 146 Bisoprolol 1.25mg tablets : 1073