Static outliers for Nexus Health Group

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 Nexus Health Group is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Asenapine 12 Drugs used for mania and hypomania 517 0.02 0.00 0.00 4.79
Cefadroxil 6 Cephalosporins 170 0.04 0.00 0.01 4.16
Emulsifying wax 232 Emollients 1981 0.12 0.01 0.03 3.58
Paraldehyde 25 Drugs used in status epilepticus 87 0.29 0.01 0.08 3.51
Dextromethorphan hydrobromide 4 Cough suppressants 18 0.22 0.01 0.06 3.44

Prescribing where Nexus Health Group is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Oxybutynin 218 Drugs for urinary frequency enuresis and incontinence 3578 0.06 0.18 0.09 -1.32
Aspirin 6769 Antiplatelet drugs 11792 0.57 0.65 0.06 -1.29
Phytomenadione 0 Vitamin K 4 0.00 0.60 0.47 -1.29
Quetiapine 1072 Antipsychotic drugs 5553 0.19 0.35 0.12 -1.27
Colecalciferol 11228 Vitamin D 12023 0.93 0.96 0.02 -1.18
Colecalciferol 800unit capsules : 1998
Colecalciferol 1,000unit tablets : 82
Colecalciferol 1,000unit capsules : 187
Colecalciferol 400unit capsules : 97
Colecalciferol 400unit / Calcium carbonate 1.5g tablets : 77
Colecalciferol 200unit / Calcium carbonate 1.25g chew tab : 211
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 709
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 2426
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 206
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 183
Colecalciferol 20,000unit tablets : 39
Colecalciferol 800unit tablets : 257
Colecalciferol 40,000unit capsules : 37
Colecalciferol 20,000unit capsules : 138
Accrete D3 tablets : 38
Adcal-D3 chewable tablets tutti frutti : 1000
Adcal-D3 Lemon chewable tablets : 133
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 86
Adcal-D3 750mg/200unit caplets : 699
Calceos 500mg/400unit chewable tablets : 87
Calcichew D3 chewable tablets : 110
Calcichew D3 Forte chewable tablets : 190
Calcichew D3 1000mg/800unit Once Daily chewable tablets : 36
SunVit-D3 800unit tablets : 29
Fultium-D3 800unit capsules : 502
Fultium-D3 20,000unit capsules : 96
Bio-Vitamin D3 800unit capsules : 54
Desunin 800unit tablets : 631
Evacal D3 1500mg/400unit chewable tablets : 123
InVita D3 800unit capsules : 199
Stexerol-D3 1,000unit tablets : 312
Colecalciferol 3,000unit tablets : 2
Colecalciferol 10,000unit tablets : 2
Colecalciferol 200units/drop oral drops sugar free : 2
Colecalciferol 3,200unit capsules : 2
Cacit D3 effervescent granules sachets : 2
SunVit-D3 400unit tablets : 2
SunVit-D3 800unit capsules : 2
TheiCal-D3 1000mg/880unit chewable tablets : 2
Stexerol-D3 25,000unit tablets : 2
Colecalciferol 400units/dose oral spray sugar free : 1
Colecalciferol 2,400units/ml oral drops sugar free : 1
Colecalciferol 2,740units/ml oral drops sugar free : 1
Colecalciferol 10,000unit capsules : 1
Colecalciferol 200units/drop oral drops : 1
BabyD 1,000units/ml oral solution : 1
Accrete D3 One a Day 1000mg/880unit chewable tablets : 1
Valupak Vitamin D3 1,000unit capsules : 1
SunVit-D3 1,000unit tablets : 1
SunVit-D3 400unit capsules : 1
SunVit-D3 10,000unit capsules : 1
SunVit-D3 1,000unit capsules : 1
Pro D3 forte 3,000units/ml liquid : 1
Desunin 4,000unit tablets : 1
Kora LiquiD 3000units/ml oral solution : 1
InVita D3 2,400units/ml oral drops : 1
InVita D3 400unit capsules : 1
Strivit-D3 800unit capsules : 1
Colecalciferol 400unit tablets : 14
ColeKal-D3 800unit tablets : 14
Colecalciferol 50,000unit capsules : 9
Valupak Vitamin D3 1,000unit tablets : 9
Thorens 10,000units/ml oral drops : 18
Plenachol D3 20,000unit capsules : 27
Plenachol D3 40,000unit capsules : 27
Colecalciferol 2,000unit tablets : 8
Colecalciferol 4,000unit tablets : 8
Natecal D3 600mg/400unit chewable tablets : 8
Hux D3 20,000unit capsules : 8
Thorens 25,000units/2.5ml oral solution : 8
Colecalciferol 2,000units/ml oral drops sugar free : 3
Colecalciferol 10,000units/ml oral drops sugar free : 3
Colecalciferol 400units/ml oral drops sugar free : 3
Bio-Vitamin D3 1,000unit capsules : 3
Aciferol D3 1,000unit tablets : 3
Thorens 25,000unit capsules : 3
Colecalciferol 800unit/Calcium phosphate 3.1g oral pdr sach : 12
Fultium-D3 3,200unit capsules : 6
Aciferol D3 400unit tablets : 6
Colecalciferol 440unit/Calcium carb 1.25g efferv gran sach : 10
Fultium-D3 2,740units/ml oral drops : 5
HealthAid Vitamin D3 200units/drop oral drops : 5