Static outliers for Northamptonshire STP

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 Northamptonshire STP is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Mesuximide 1 Control of epilepsy 167273 0.00 0.00 0.00 6.33
Empagliflozin/metformin 4574 Other antidiabetic drugs 82853 0.06 0.01 0.01 5.47
Bifonazole 6 Antifungal preparations 4633 0.00 0.00 0.00 4.95
Felbamate 6 Control of epilepsy 167273 0.00 0.00 0.00 4.94
Nefopam hydrochloride 12306 Non-opioid analgesics and compound preparations 203904 0.06 0.01 0.01 4.58

Prescribing where Northamptonshire STP is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Duloxetine hydrochloride 702 Drugs for urinary frequency enuresis and incontinence 42012 0.02 0.04 0.01 -3.37
Salicylic acid 36 Preparations for warts and calluses 240 0.15 0.65 0.17 -2.91
Ispaghula husk 7936 Bulk-forming laxatives 9051 0.88 0.96 0.03 -2.72
Colecalciferol 99545 Vitamin D 105505 0.94 0.97 0.01 -2.48
Colecalciferol 3,000unit tablets : 18
Colecalciferol 800unit capsules : 3765
Colecalciferol 600unit capsules : 2
Colecalciferol 1,000unit tablets : 183
Colecalciferol 1,000unit capsules : 137
Colecalciferol 400unit capsules : 234
Colecalciferol 400unit / Calcium carbonate 1.5g tablets : 44
Colecalciferol 2,000units/ml oral drops sugar free : 13
Colecalciferol 200unit / Calcium carbonate 1.25g chew tab : 190
Colecalciferol 400unit / Calcium carbonate 1.25g chew tab : 869
Colecalciferol 440unit/Calcium carb 1.25g efferv gran sach : 60
Colecalciferol 400unit / Calcium carbonate 1.5g chewable tab : 1954
Colecalciferol 800unit/Calcium phosphate 3.1g oral pdr sach : 64
Colecalciferol 400unit / Calcium carbonate 1.5g efferv tab : 385
Colecalciferol 400unit / Calcium carbonate 1.25g tablets : 16
Colecalciferol 200unit / Calcium carbonate 750mg tablets : 392
Colecalciferol 400units/dose oral spray sugar free : 5
Colecalciferol 5,000unit tablets : 9
Colecalciferol 2,200unit tablets : 10
Colecalciferol 10,000unit tablets : 17
Colecalciferol 20,000unit tablets : 19
Colecalciferol 800unit tablets : 694
Colecalciferol 40,000unit capsules : 2
Colecalciferol 50,000unit tablets : 20
Colecalciferol 2,000unit tablets : 44
Colecalciferol 3,200unit capsules : 121
Colecalciferol 25,000units/1ml soln ud amp sugar free : 86
Colecalciferol 880unit / Calcium carbonate 2.5g chew tab : 138
Colecalciferol 25,000unit tablets : 8
Colecalciferol 800unit / Calcium carbonate 2.5g chewable tab : 99
Colecalciferol 10,000units/ml oral drops sugar free : 4
Colecalciferol 10,000units/ml oral solution sugar free : 3
Colecalciferol 2,400units/ml oral drops sugar free : 16
Colecalciferol 20,000unit capsules : 48
Colecalciferol 2,740units/ml oral drops sugar free : 1
Colecalciferol 50,000units/1ml soln ud amp sugar free : 53
Colecalciferol 5,000unit capsules : 3
Colecalciferol 1,000unit / Calcium carbonate 2.5g chew tab : 84
Colecalciferol 4,000unit tablets : 61
Colecalciferol 5,600unit capsules : 23
Colecalciferol 25,000unit capsules : 59
Colecalciferol 400unit tablets : 344
Colecalciferol 10,000units/5ml oral solution sugar free : 2
Colecalciferol 50,000unit capsules : 208
Colecalciferol 400unit chewable tablets : 9
Colecalciferol 400units/ml oral drops sugar free : 7
Colecalciferol 200units/drop oral drops : 9
Pro D3 400unit capsules : 4
Pro D3 1,000unit capsules : 13
Pro D3 10,000unit capsules : 5
Pro D3 20,000unit capsules : 6
Pro D3 2,000units/ml liquid drops : 51
Pro D3 2,000units/ml liquid : 4
Accrete D3 tablets : 7364
Accrete D3 One a Day 1000mg/880unit chewable tablets : 312
Valupak Vitamin D3 1,000unit tablets : 29
Valupak Vitamin D3 1,000unit capsules : 1
Adcal-D3 chewable tablets tutti frutti : 7075
Adcal-D3 Lemon chewable tablets : 1332
Adcal-D3 Dissolve 1500mg/400unit effervescent tablets : 1589
Adcal-D3 750mg/200unit caplets : 13686
Cacit D3 effervescent granules sachets : 71
Calceos 500mg/400unit chewable tablets : 1069
Calcichew D3 chewable tablets : 471
Calcichew D3 Forte chewable tablets : 866
Calcichew D3 500mg/400unit caplets : 26
Calcichew D3 1000mg/800unit Once Daily chewable tablets : 69
Calfovit D3 oral powder sachets : 102
Natecal D3 600mg/400unit chewable tablets : 17
SunVit-D3 1,000unit tablets : 12
SunVit-D3 10,000unit tablets : 5
SunVit-D3 20,000unit tablets : 1
SunVit-D3 2,000unit tablets : 1
SunVit-D3 5,000unit tablets : 2
SunVit-D3 2,000units/ml oral drops : 1
SunVit-D3 400unit tablets : 6
SunVit-D3 800unit tablets : 35
SunVit-D3 400unit capsules : 6
SunVit-D3 3,000units/ml oral solution : 2
SunVit-D3 800unit capsules : 2
SunVit-D3 400unit Vegan tablets : 3
Fultium-D3 800unit capsules : 3799
Fultium-D3 3,200unit capsules : 220
Fultium-D3 20,000unit capsules : 11
Fultium-D3 2,740units/ml oral drops : 7
DLux 400 oral spray : 1
Pro D3 forte 3,000units/ml liquid : 3
Hux D3 20,000unit capsules : 26
Aciferol D3 400unit tablets : 11
Aciferol D3 1,000unit tablets : 8
Aciferol D3 2,200unit tablets : 3
Aciferol D3 3,000unit tablets : 3
Aciferol D3 10,000unit tablets : 63
Aciferol D3 50,000unit capsules : 1
Aciferol D3 3,000units/ml liquid : 41
Aciferol D3 2,000units/ml liquid : 7
Desunin 800unit tablets : 100
Desunin 4,000unit tablets : 77
OsteoCaps D3 1,000unit capsules : 1
Evacal D3 1500mg/400unit chewable tablets : 41227
Vitamin D3 High Strength 5,000unit tablets : 1
Vitamin D3 Lemon Melts 2,000unit tablets : 1
Kora LiquiD 3000units/ml oral solution : 3
InVita D3 25,000units/1ml oral solution : 1184
InVita D3 2,400units/ml oral drops : 5
InVita D3 50,000units/1ml oral solution : 593
InVita D3 800unit capsules : 1686
InVita D3 400unit capsules : 38
InVita D3 50,000unit capsules : 1605
InVita D3 25,000unit capsules : 398
InVita D3 5,600unit capsules : 7
TheiCal-D3 1000mg/880unit chewable tablets : 1296
Stexerol-D3 1,000unit tablets : 9
Thorens 10,000units/ml oral drops : 4
Calci-D 1000mg/1,000unit chewable tablets : 2336
Iodine compounds 3 Chlorine and iodine 5 0.60 0.94 0.14 -2.45