Static outliers for North Lewisham 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 North Lewisham PCN is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Bethanechol chloride 32 Drugs for urinary retention 1351 0.02 0.0 0.0 55.71
Caffeine citrate 2 CNS Stimulants and drugs used for ADHD 707 0.00 0.0 0.0 35.41
Olmesartan medoxomil/amlodipine 158 Angiotensin-II receptor antagonists 4779 0.03 0.0 0.0 17.59
Proguanil hydrochloride with atovaquone 5 Antimalarials 383 0.01 0.0 0.0 13.30
Arnica montana 10 Rubefacients, topical NSAIDS, capsaicin and poultice 3051 0.00 0.0 0.0 10.92

Prescribing where North Lewisham PCN is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Isosorbide mononitrate 468 Nitrates 1017 0.46 0.73 0.07 -4.08
Finasteride 432 Male sex hormones and antagonists 701 0.62 0.83 0.07 -2.88
Potassium permanganate 3 Oxidisers and dyes 8 0.38 0.93 0.20 -2.82
Codeine phosphate 7 Cough suppressants 29 0.24 0.78 0.21 -2.56
Colecalciferol 7049 Vitamin D 7505 0.94 0.97 0.01 -1.84
Colecalciferol 3,000unit tablets : 11
Colecalciferol 800unit capsules : 759
Colecalciferol 600unit capsules : 2
Colecalciferol 1,000unit tablets : 246
Colecalciferol 1,000unit capsules : 68
Colecalciferol 400unit capsules : 102
Colecalciferol 400unit / Calcium carbonate 1.5g tablets : 10
Colecalciferol 2,000units/ml oral drops sugar free : 9
Colecalciferol 200unit / Calcium carbonate 1.25g chew tab : 51
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 191
Colecalciferol 440unit/Calcium carb 1.25g efferv gran sach : 12
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 983
Colecalciferol 800unit/Calcium phosphate 3.1g oral pdr sach : 9
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 106
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 186
Colecalciferol 5,000unit tablets : 2
Colecalciferol 10,000unit tablets : 3
Colecalciferol 20,000unit tablets : 70
Colecalciferol 800unit tablets : 920
Colecalciferol 40,000unit capsules : 33
Colecalciferol 50,000unit tablets : 1
Colecalciferol 200units/drop oral drops sugar free : 5
Colecalciferol 2,000unit tablets : 53
Colecalciferol 2,000unit orodispersible tablets sugar free : 1
Colecalciferol 3,200unit capsules : 119
Colecalciferol 25,000units/1ml soln ud amp sugar free : 1
Colecalciferol 880unit / Calcium carbonate 2.5g chew tab : 2
Colecalciferol 25,000unit tablets : 18
Colecalciferol 10,000units/ml oral drops sugar free : 5
Colecalciferol 10,000units/ml oral solution sugar free : 4
Colecalciferol 20,000unit capsules : 181
Colecalciferol 2,740units/ml oral drops sugar free : 14
Colecalciferol 10,000unit capsules : 2
Colecalciferol 2,200unit capsules : 2
Colecalciferol 2,500unit capsules : 1
Colecalciferol 5,000unit capsules : 2
Colecalciferol 4,000unit tablets : 12
Colecalciferol 400unit tablets : 84
Colecalciferol 50,000unit capsules : 1
Colecalciferol 200units/drop oral drops : 47
BabyD 1,000units/ml oral solution : 6
Pro D3 400unit capsules : 1
Pro D3 1,000unit capsules : 2
Pro D3 10,000unit capsules : 2
Accrete D3 tablets : 27
Valupak Vitamin D3 1,000unit tablets : 14
Adcal-D3 chewable tablets tutti frutti : 865
Adcal-D3 Lemon chewable tablets : 76
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 64
Adcal-D3 750mg/200unit caplets : 649
Cacit D3 effervescent granules sachets : 1
Calceos 500mg/400unit chewable tablets : 22
Calcichew D3 chewable tablets : 68
Calcichew D3 Forte chewable tablets : 76
Calfovit D3 oral powder sachets : 3
SunVit-D3 20,000unit tablets : 1
SunVit-D3 2,200unit capsules : 2
SunVit-D3 10,000unit capsules : 3
SunVit-D3 1,000unit Vegan tablets : 1
Fultium-D3 800unit capsules : 139
Fultium-D3 3,200unit capsules : 27
Fultium-D3 20,000unit capsules : 8
Fultium-D3 2,740units/ml oral drops : 5
Bio-Vitamin D3 800unit capsules : 3
Bio-Vitamin D3 5,000unit capsules : 1
Hux D3 20,000unit capsules : 100
Aciferol D3 400unit tablets : 1
Desunin 800unit tablets : 274
Desunin 4,000unit tablets : 1
Plenachol D3 40,000unit capsules : 1
OsteoCaps D3 20,000unit capsules : 1
OsteoCaps D3 1,000unit capsules : 6
Evacal D3 1500mg/400unit chewable tablets : 26
HealthAid Vitamin D3 200units/drop oral drops : 4
Kora LiquiD 3000units/ml oral solution : 1
InVita D3 800unit capsules : 23
InVita D3 400unit capsules : 3
TheiCal-D3 1000mg/880unit chewable tablets : 4
Stexerol-D3 1,000unit tablets : 159
Stexerol-D3 25,000unit tablets : 27
Thorens 10,000units/ml oral drops : 5
Thorens 25,000units/2.5ml oral solution : 1
Calci-D 1000mg/1,000unit chewable tablets : 14
Strivit-D3 800unit capsules : 1
ColeKal-D3 800unit capsules : 1
ColeKal-D3 800unit tablets : 2