Static outliers for Lightwater 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 Lightwater Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Cefixime 2 Cephalosporins 28 0.07 0.00 0.01 7.16
Paraffin soft yellow 18 Tear deficiency, eye lubricant/astringent 147 0.12 0.01 0.02 6.74
Lormetazepam 6 Hypnotics 239 0.03 0.00 0.01 4.05
Testosterone enantate 5 Male sex hormones and antagonists 185 0.03 0.00 0.01 3.95
Glucagon 1 Treatment of hypoglycaemia 1 1.00 0.24 0.20 3.70

Prescribing where Lightwater Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Glucose 0 Treatment of hypoglycaemia 1 0.00 0.75 0.21 -3.62
Zinc oxide 1 Soothing haemorrhoidal preparations 8 0.12 0.77 0.27 -2.42
Prucalopride 0 Other drugs used in constipation 9 0.00 0.71 0.33 -2.18
Colecalciferol 1202 Vitamin D 1314 0.91 0.96 0.02 -1.96
Colecalciferol 800unit capsules : 144
Colecalciferol 1,000unit tablets : 77
Colecalciferol 400unit capsules : 44
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 30
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 321
Colecalciferol 2,000unit tablets : 32
Adcal-D3 chewable tablets tutti frutti : 175
Adcal-D3 Lemon chewable tablets : 35
Adcal-D3 750mg/200unit caplets : 90
Fultium-D3 800unit capsules : 75
Colecalciferol 440unit/Calcium carb 1.25g efferv gran sach : 2
Colecalciferol 400units/dose oral spray sugar free : 2
Colecalciferol 25,000units/1ml soln ud amp sugar free : 2
Colecalciferol 25,000unit tablets : 2
Colecalciferol 50,000unit capsules : 2
Strivit-D3 800unit capsules : 2
Colecalciferol 600unit capsules : 1
Colecalciferol 2,000units/ml oral drops sugar free : 1
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 1
Colecalciferol 50,000unit tablets : 1
Colecalciferol 200units/drop oral drops sugar free : 1
Colecalciferol 2,740units/ml oral drops sugar free : 1
Colecalciferol 400units/ml oral drops sugar free : 1
Colecalciferol 200units/drop oral drops : 1
Pro D3 800unit Vegan capsules : 1
Fultium-D3 2,740units/ml oral drops : 1
InVita D3 25,000units/1ml oral solution : 1
InVita D3 400unit capsules : 1
InVita D3 50,000unit capsules : 1
TheiCal-D3 1000mg/880unit chewable tablets : 1
Colecalciferol 1,000unit capsules : 14
Colecalciferol 4,000unit tablets : 9
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 4
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 4
Fultium-D3 3,200unit capsules : 4
Colecalciferol 3,000unit tablets : 3
Pro D3 2,500unit capsules : 3
Colecalciferol 10,000units/ml oral drops sugar free : 7
Calcichew D3 Forte chewable tablets : 21
Accrete D3 tablets : 16
Colecalciferol 3,200unit capsules : 11
Colecalciferol 2,500unit capsules : 6
Evacal D3 1500mg/400unit chewable tablets : 6
Colecalciferol 200unit / Calcium carbonate 1.25g chew tab : 10
Colecalciferol 800unit tablets : 10
Calcichew D3 chewable tablets : 10
Colecalciferol 800unit/Calcium phosphate 3.1g oral pdr sach : 5
Colecalciferol 20,000unit capsules : 5
Desunin 800unit tablets : 5
Ibuprofen 43 Rubefacients, topical NSAIDS, capsaicin and poultice 358 0.12 0.52 0.20 -1.95