Static outliers for Mmwf 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 Mmwf PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Etanercept 1 Rheumatic disease suppressant drugs 941 0.00 0.00 0.00 16.81
Doxycycline hyclate 14 Drugs for oral ulceration and inflammation 107 0.13 0.00 0.01 10.98
Nefopam hydrochloride 1295 Non-opioid analgesics and compound preparations 10265 0.13 0.01 0.01 8.44
Trimetazidine hydrochloride 12 Calcium-channel blockers 16003 0.00 0.00 0.00 7.55
Triptorelin acetate 95 Prostate cancer and gonadorelin analogues 269 0.35 0.02 0.05 7.16

Prescribing where Mmwf PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Trimethoprim 202 Sulfonamides and trimethoprim 296 0.68 0.87 0.07 -2.79
Ivermectin 9 Topical preparation for rosacea 16 0.56 0.88 0.12 -2.69
Colecalciferol 6350 Vitamin D 6833 0.93 0.97 0.01 -2.54
Colecalciferol 3,000unit tablets : 4
Colecalciferol 800unit capsules : 262
Colecalciferol 1,000unit tablets : 1
Colecalciferol 1,000unit capsules : 3
Colecalciferol 400unit capsules : 26
Colecalciferol 2,000units/ml oral drops sugar free : 8
Colecalciferol 200unit / Calcium carbonate 1.25g chew tab : 3
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 62
Colecalciferol 440unit/Calcium carb 1.25g efferv gran sach : 1
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 40
Colecalciferol 800unit/Calcium phosphate 3.1g oral pdr sach : 25
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 27
Colecalciferol 400unit / Calcium carbonate 1.25g tablets : 10
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 46
Colecalciferol 400units/dose oral spray sugar free : 3
Colecalciferol 5,000unit tablets : 2
Colecalciferol 10,000unit tablets : 2
Colecalciferol 800unit tablets : 212
Colecalciferol 50,000unit tablets : 7
Colecalciferol 25,000units/1ml soln ud amp sugar free : 14
Colecalciferol 800unit / Calcium carbonate 2.5g chewable tab : 6
Colecalciferol 10,000units/ml oral drops sugar free : 4
Colecalciferol 2,400units/ml oral drops sugar free : 6
Colecalciferol 50,000units/1ml soln ud amp sugar free : 3
Colecalciferol 4,000unit tablets : 22
Colecalciferol 5,600unit capsules : 3
Colecalciferol 25,000unit capsules : 13
Colecalciferol 400unit tablets : 29
Colecalciferol 10,000units/5ml oral solution sugar free : 1
Colecalciferol 50,000unit capsules : 124
Colecalciferol 400units/ml oral drops sugar free : 4
Pro D3 10,000unit capsules : 5
Pro D3 2,000units/ml liquid drops : 5
Accrete D3 tablets : 263
Accrete D3 One a Day 1000mg/880unit chewable tablets : 24
Valupak Vitamin D3 1,000unit tablets : 5
Adcal-D3 chewable tablets tutti frutti : 484
Adcal-D3 Lemon chewable tablets : 29
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 149
Adcal-D3 750mg/200unit caplets : 1256
Calceos 500mg/400unit chewable tablets : 25
Calcichew D3 chewable tablets : 7
Calcichew D3 Forte chewable tablets : 73
Calcichew D3 500mg/400unit caplets : 7
Calcichew D3 1000mg/800unit Once Daily chewable tablets : 6
SunVit-D3 10,000unit tablets : 1
SunVit-D3 800unit tablets : 4
Fultium-D3 800unit capsules : 175
Fultium-D3 20,000unit capsules : 1
Aciferol D3 10,000unit tablets : 6
Aciferol D3 3,000units/ml liquid : 1
Desunin 800unit tablets : 6
Desunin 4,000unit tablets : 3
Evacal D3 1500mg/400unit chewable tablets : 2067
InVita D3 25,000units/1ml oral solution : 121
InVita D3 50,000units/1ml oral solution : 94
InVita D3 800unit capsules : 146
InVita D3 400unit capsules : 5
InVita D3 50,000unit capsules : 105
InVita D3 25,000unit capsules : 14
TheiCal-D3 1000mg/880unit chewable tablets : 4
Thorens 10,000units/ml oral drops : 1
Calci-D 1000mg/1,000unit chewable tablets : 285
Macrogol 3350 1136 Osmotic laxatives 2056 0.55 0.72 0.07 -2.33
Macrogol compound oral powder sachets NPF sugar free : 30
Macrogol compound half-strength oral pdr sach NPF sugar free : 20
Macrogol compound oral powder sachets NPF : 3
Movicol oral powder 13.8g sachets lemon & lime : 7
Movicol-Half oral powder 6.9g sachets : 2
Movicol Plain oral powder 13.7g sachets : 24
Movicol Chocolate oral powder 13.9g sachets : 1
Movicol Paediatric Plain oral powder 6.9g sachets : 75
Movicol Paediatric Chocolate oral powder 6.9g sachets : 7
Laxido Orange oral powder sachets sugar free : 718
Laxido Paediatric Plain oral powder 6.9g sachets : 152
CosmoCol Orange Lemon and Lime oral powder sachets : 10
CosmoCol Orange Flavour oral powder sachets : 1
CosmoCol Lemon and Lime Flavour oral powder sachets : 20
CosmoCol Paediatric oral powder 6.9g sachets : 17
CosmoCol Plain oral powder sachets : 49
Methylprednisolone acetate 6 Local corticosteroid injections 112 0.05 0.73 0.29 -2.32