Static outliers for Jersey Practice

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 Jersey Practice is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Pitolisant hydrochloride 10 CNS Stimulants and drugs used for ADHD 32 0.31 0.00 0.00 122.61
Brivaracetam 64 Control of epilepsy 1890 0.03 0.00 0.00 8.44
Hyoscine hydrobromide 122 Drugs used in nausea and vertigo 507 0.24 0.02 0.03 6.62
Methylprednisolone 4 Use of corticosteroids 211 0.02 0.00 0.00 6.30
Cariprazine 6 Antipsychotic drugs 1160 0.01 0.00 0.00 5.86

Prescribing where Jersey Practice is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Potassium permanganate 0 Oxidisers and dyes 1 0.00 0.94 0.22 -4.21
Prednisolone 139 Use of corticosteroids 211 0.66 0.88 0.06 -3.51
Colecalciferol 1756 Vitamin D 1980 0.89 0.96 0.02 -3.08
Colecalciferol 800unit capsules : 99
Colecalciferol 1,000unit capsules : 75
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 63
Colecalciferol 20,000unit capsules : 67
Accrete D3 tablets : 405
Adcal-D3 chewable tablets tutti frutti : 46
Adcal-D3 750mg/200unit caplets : 91
Calceos 500mg/400unit chewable tablets : 165
Calcichew D3 Forte chewable tablets : 60
Fultium-D3 800unit capsules : 166
Fultium-D3 20,000unit capsules : 31
InVita D3 25,000units/1ml oral solution : 54
Stexerol-D3 25,000unit tablets : 277
Colecalciferol 400unit / Calcium carbonate 1.25g tablets : 2
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 2
Calcichew D3 chewable tablets : 2
Colecalciferol 2,000units/ml oral drops sugar free : 1
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 1
Colecalciferol 10,000unit tablets : 1
Colecalciferol 25,000unit tablets : 1
Colecalciferol 400unit tablets : 1
Colecalciferol 50,000unit capsules : 1
Fultium-D3 3,200unit capsules : 1
InVita D3 50,000unit capsules : 1
TheiCal-D3 1000mg/880unit chewable tablets : 1
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 9
Calci-D 1000mg/1,000unit chewable tablets : 9
Thorens 25,000units/2.5ml oral solution : 4
Colecalciferol 1,000unit tablets : 27
InVita D3 2,400units/ml oral drops : 3
Hux D3 20,000unit capsules : 26
Desunin 800unit tablets : 21
InVita D3 50,000units/1ml oral solution : 16
Colecalciferol 20,000unit tablets : 6
Accrete D3 One a Day 1000mg/880unit chewable tablets : 6
Stexerol-D3 1,000unit tablets : 15
Theophylline 6 Theophylline 38 0.16 0.83 0.25 -2.74
Alcohol 0 Alcohols and saline 2 0.00 0.87 0.33 -2.61