Static outliers for Gravesend Central 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 Gravesend Central PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Arachis oil 4 Shampoos and some other scalp preparations 134 0.03 0.00 0.00 25.74
Tiaprofenic acid 20 Non-steroidal anti-inflammatory drugs 2325 0.01 0.00 0.00 19.63
Posaconazole 5 Triazole antifungals 58 0.09 0.00 0.01 17.06
Piroxicam 39 Non-steroidal anti-inflammatory drugs 2325 0.02 0.00 0.00 9.77
Acitretin 24 Preparations for psoriasis 231 0.10 0.01 0.01 8.63

Prescribing where Gravesend Central PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pseudoephedrine hydrochloride 1 Systemic nasal decongestants 3 0.33 0.95 0.18 -3.54
Mirtazapine 1213 Other antidepressant drugs 3222 0.38 0.56 0.07 -2.63
Folic acid 1497 Drugs used in megaloblastic anaemias 4448 0.34 0.68 0.13 -2.62
Colecalciferol 6219 Vitamin D 6687 0.93 0.97 0.01 -2.49
Colecalciferol 3,000unit tablets : 21
Colecalciferol 800unit capsules : 1087
Colecalciferol 1,000unit tablets : 132
Colecalciferol 1,000unit capsules : 40
Colecalciferol 400unit capsules : 7
Colecalciferol 400unit / Calcium carbonate 1.5g tablets : 49
Colecalciferol 2,000units/ml oral drops sugar free : 1
Colecalciferol 200unit / Calcium carbonate 1.25g chew tab : 13
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 73
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 159
Colecalciferol 800unit/Calcium phosphate 3.1g oral pdr sach : 6
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 56
Colecalciferol 20,000unit tablets : 5
Colecalciferol 800unit tablets : 166
Colecalciferol 40,000unit capsules : 4
Colecalciferol 200units/drop oral drops sugar free : 3
Colecalciferol 2,000unit tablets : 1
Colecalciferol 3,200unit capsules : 110
Colecalciferol 20,000unit capsules : 21
Colecalciferol 10,000unit capsules : 2
Colecalciferol 2,500unit capsules : 1
Colecalciferol 1,000unit / Calcium carbonate 2.5g chew tab : 3
Colecalciferol 4,000unit tablets : 3
Colecalciferol 5,600unit capsules : 1
Colecalciferol 400unit tablets : 8
Colecalciferol 50,000unit capsules : 2
Colecalciferol 200units/drop oral drops : 12
Pro D3 2,000units/ml liquid : 4
Accrete D3 tablets : 379
Adcal-D3 chewable tablets tutti frutti : 486
Adcal-D3 Lemon chewable tablets : 128
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 42
Adcal-D3 750mg/200unit caplets : 1301
Cacit D3 effervescent granules sachets : 6
Calceos 500mg/400unit chewable tablets : 53
Calcichew D3 chewable tablets : 41
Calcichew D3 Forte chewable tablets : 119
Calcichew D3 1000mg/800unit Once Daily chewable tablets : 9
SunVit-D3 1,000unit capsules : 21
Fultium-D3 800unit capsules : 680
Fultium-D3 3,200unit capsules : 104
Fultium-D3 20,000unit capsules : 19
Pro D3 forte 3,000units/ml liquid : 2
Desunin 800unit tablets : 272
Desunin 4,000unit tablets : 1
OsteoCaps D3 1,000unit capsules : 3
Evacal D3 1500mg/400unit chewable tablets : 1
InVita D3 25,000units/1ml oral solution : 1
InVita D3 400unit capsules : 1
InVita D3 25,000unit capsules : 1
Stexerol-D3 1,000unit tablets : 122
Stexerol-D3 25,000unit tablets : 1
Thorens 25,000units/2.5ml oral solution : 1
Calci-D 1000mg/1,000unit chewable tablets : 430
ColeKal-D3 1,000unit capsules : 1
SunVit-D3 400unit with Calcium 600mg chew tab tutti frutti : 3
ColeDose D3 20,000unit tablets : 1
Naftidrofuryl oxalate 0 Peripheral vasodilators and related drugs 3 0.00 0.67 0.28 -2.38