Static outliers for Hounslow Health PCN

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 Hounslow Health PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Buprenorph hydrochloride/naloxone hydrochloride 11 Opioid dependence 12 0.92 0.01 0.06 15.48
Aspirin combined preparations 3 Non-opioid analgesics and compound preparations 9222 0.00 0.00 0.00 11.57
Hydrocortisone acetate 2 Corticosteroids 27 0.07 0.00 0.01 10.26
Demeclocycline hydrochloride 40 Tetracyclines 1119 0.04 0.00 0.00 8.98
Famciclovir 20 Herpes simplex and varicella-zoster 284 0.07 0.01 0.01 7.00

Prescribing where Hounslow Health PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Colecalciferol 10969 Vitamin D 12048 0.91 0.97 0.01 -3.88
Colecalciferol 800unit capsules : 44
Colecalciferol 600unit capsules : 2
Colecalciferol 1,000unit tablets : 33
Colecalciferol 1,000unit capsules : 7
Colecalciferol 400unit / Calcium carbonate 1.5g tablets : 94
Colecalciferol 200unit / Calcium carbonate 1.25g chew tab : 27
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 228
Colecalciferol 440unit/Calcium carb 1.25g efferv gran sach : 3
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 307
Colecalciferol 800unit/Calcium phosphate 3.1g oral pdr sach : 6
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 67
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 41
Colecalciferol 5,000unit tablets : 1
Colecalciferol 20,000unit tablets : 2
Colecalciferol 800unit tablets : 17
Colecalciferol 40,000unit capsules : 3
Colecalciferol 2,000unit tablets : 1
Colecalciferol 25,000units/1ml soln ud amp sugar free : 9
Colecalciferol 880unit / Calcium carbonate 2.5g chew tab : 12
Colecalciferol 10,000units/ml oral drops sugar free : 1
Colecalciferol 2,400units/ml oral drops sugar free : 5
Colecalciferol 20,000unit capsules : 24
Colecalciferol 15,000units/5ml oral solution : 4
Colecalciferol 2,740units/ml oral drops sugar free : 2
Colecalciferol 1,000unit / Calcium carbonate 2.5g chew tab : 4
Colecalciferol 400unit tablets : 4
Colecalciferol 50,000unit capsules : 1
Colecalciferol 400units/ml oral drops sugar free : 1
Solgar Vitamin D3 2,200unit capsules : 1
Pro D3 1,000unit capsules : 9
Pro D3 2,000units/ml liquid : 1
Pro D3 800unit capsules : 1
Accrete D3 tablets : 4457
Accrete D3 One a Day 1000mg/880unit chewable tablets : 28
Valupak Vitamin D3 1,000unit tablets : 60
Adcal-D3 chewable tablets tutti frutti : 414
Adcal-D3 Lemon chewable tablets : 109
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 32
Adcal-D3 750mg/200unit caplets : 1189
Cacit D3 effervescent granules sachets : 2
Calceos 500mg/400unit chewable tablets : 400
Calcichew D3 chewable tablets : 41
Calcichew D3 Forte chewable tablets : 211
Calcichew D3 1000mg/800unit Once Daily chewable tablets : 9
Calfovit D3 oral powder sachets : 12
SunVit-D3 20,000unit tablets : 102
SunVit-D3 5,000unit tablets : 2
Fultium-D3 800unit capsules : 96
Fultium-D3 3,200unit capsules : 15
Fultium-D3 20,000unit capsules : 121
Fultium-D3 2,740units/ml oral drops : 1
Pro D3 forte 3,000units/ml liquid : 16
Hux D3 20,000unit capsules : 827
Hux D3 3,200unit capsules : 1
Desunin 800unit tablets : 1
InVita D3 25,000units/1ml oral solution : 506
InVita D3 2,400units/ml oral drops : 20
InVita D3 50,000units/1ml oral solution : 1
InVita D3 800unit capsules : 86
InVita D3 50,000unit capsules : 1
InVita D3 25,000unit capsules : 5
TheiCal-D3 1000mg/880unit chewable tablets : 1
Stexerol-D3 1,000unit tablets : 78
Stexerol-D3 25,000unit tablets : 486
Calci-D 1000mg/1,000unit chewable tablets : 677
Simvastatin 2624 Lipid-regulating drugs 37182 0.07 0.22 0.05 -2.96
Vitamin A 0 Vitamin A 3 0.00 0.83 0.30 -2.74
Other multivitamin preparations 256 Multivitamin preparations 594 0.43 0.80 0.14 -2.64
Spironolactone 876 Potassium-sparing diuretics and aldosterone antagonists 1832 0.48 0.72 0.10 -2.55