Static outliers for Chalfont Road Surgery

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 Chalfont Road Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ergocalciferol 52 Vitamin D 585 0.09 0.00 0.01 13.64
Gluten free/low protein pasta 13 Foods for special diets 62 0.21 0.00 0.02 11.66
Propafenone hydrochloride 3 Drugs for arrhythmias 5 0.60 0.02 0.05 10.77
Low protein cakes 3 Foods for special diets 62 0.05 0.00 0.01 8.95
Gluten free/low protein bread 12 Foods for special diets 62 0.19 0.01 0.02 8.91

Prescribing where Chalfont Road Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Ivermectin 0 Topical preparation for rosacea 1 0.00 0.88 0.24 -3.72
Alginic acid compound preparations 44 Compound Alginates and proprietary indigestion preparations 46 0.96 1.00 0.01 -2.97
Lidocaine hydrochloride 4 Local anaesthetics 8 0.50 0.91 0.14 -2.93
Colecalciferol 522 Vitamin D 585 0.89 0.96 0.02 -2.86
Valupak Vitamin D3 1,000unit tablets : 56
Adcal-D3 chewable tablets tutti frutti : 60
Calceos 500mg/400unit chewable tablets : 67
Calcichew D3 Forte chewable tablets : 33
Fultium-D3 800unit capsules : 71
Hux D3 20,000unit capsules : 78
Evacal D3 1500mg/400unit chewable tablets : 57
Colecalciferol 2,000unit tablets : 2
Colecalciferol 600unit capsules : 1
Colecalciferol 1,000unit tablets : 1
Colecalciferol 400unit capsules : 1
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 1
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 1
Colecalciferol 200units/drop oral drops : 1
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 4
SunVit-D3 10,000unit tablets : 4
Aciferol D3 1,000unit tablets : 4
Calcichew D3 chewable tablets : 8
SunVit-D3 20,000unit tablets : 22
Adcal-D3 Lemon chewable tablets : 3
Accrete D3 tablets : 12
Adcal-D3 750mg/200unit caplets : 15
Accrete D3 One a Day 1000mg/880unit chewable tablets : 10
Colecalciferol 800unit tablets : 5
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 5
Other emollient preparations 151 Emollients 208 0.73 0.89 0.07 -2.33