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Technical report 3:dual energy x-ray absorptiometry (DXA) services in Ireland. How do we fare? National survey of services in Ireland (October – December 2006) technical report to NCAOP/HSE/DOHC

Year: 2007
Type: report
Study design: Observational Study
Abstract: The clinical significance of osteoporosis lies in the fractures that arise and their attendant morbidity and mortality.Measurements of bone mineral density (BMD) by Dual energy X-ray Absorptiometry (DXA) are central to the diagnosis and assessment of osteoporosis.Given a prevalence of osteoporosis of 1 / 3 women and 1 / 5 men over 50 years of age 1 , with the associated risk of fractures, DXA service provision is a core health service, the delivery of which should be in a planned manner.In 1998 the European Commission recommended that access to bone densitometry should be universal for people with accepted clinical indicators. 1 Kanis in 2003 compared DXA needs of various European countries to their current supply.2 Figures for Ireland were not available.This Irish survey addresses the information deficit as well as providing a baseline view of current DXA services in Ireland.61 DXA scanners (59 locations) were identified.59 were staffed, of which 53 (89%) participated in the survey.Based on the population of each hospital network, the DXA machine density ranged from 1/46,000 to 1/122,000.The annual number of scans per 100,000 population ranged from 1,025 to 3,053 (approximately).Twenty-two (37%) of the DXA locations were in Public Hospitals, 15 (25%) were in Primary Care.Nine (15.5%) were free to all patients, 36 (61%) charged all, the remainder were mixed, in that there were criteria for charging in some cases.The number of DXA services which were free to all users across the Networks ranged from 0 to 3, while of those with a mixture of free to charge the percentage varied from 10:90 to 40:60.Only five of the 22 Public Hospitals provided 10 scan sessions per week -worked to full capacity.19 scanners had waiting times of more than two weeks, 18 of these were in Public Hospitals.This ranged from 2-52 weeks with a median of 16 weeks.The services provided ranged from providing a scan only, to providing a full clinical work up and treatment.The scan report varied from scanner print-out to interpretation with respect to risk factors and advice on therapy.The majority of DXA operators routinely scanned the spine.Almost equal numbers scanned one or two hip sites.60% had written protocols in place.All had a procedure in place if daily quality control (QC) failed.There were wide variations in training and continuous professional development (CPD) both in terms of content, quality and frequency, aspects of which were recurrent concerns in comments received.Recurrent themes were evident in the comments of which there were over 250.Kanis et al 2 in their survey reported wide variables in the availability of DXAs in European countries.Like Kanis 2 this survey suggests inequity in terms of geography, waiting time, cost and access to DXAs.In addition to accessibility to DXAs to meet the needs of patients with known risk factors, the requirements are for quality DXA services.At national level standards are needed to ensure such a quality service both in terms of protocols and guidelines in line with best international practice and to facilitate audit both of the DXA service itself, and the wider aspects of who is scanned, what happens those who are scanned and to ensure that those who should be scanned are actually scanned.Respondents identified the need for recognised Irish standardised training and updates for DXA providers and for the wider aspects of the osteoporosis service available at national and regional level.A number of recommendations are made, the implementation of which, are needed to address current deficits in the service. RecommendationsThis report addresses issues around DXA services in Ireland.However, there is an overlap with the wider area of osteoporosis, assessment and treatment.DXA services should be part of a multi-disciplinary osteoporosis service from assessment to management. Public Awareness:• The public require ongoing evaluated sources of information on bone health so that those with risk factors can seek appropriate assessment including DXA which would reduce requests for DXA from those at low risk.• Ongoing supplies of information on all aspects of bone health including DXAs should be available in public areas such as libraries and also in all health care settings including DXA waiting areas.The quantity and frequency of delivery to latter areas should be based on numbers is attendance. National bone health office:A National bone health office with a small number of staff is recommended.The staff would provide and source expertise, act as conduit for developments, and highlight trends and issues.Such an office with regional and local networks could greatly facilitate progression of the following items:• Regulations regarding the running of DXA scan units are needed at national level • A National office could help harmonize policies on all aspects of BMD and DXATesting • The above would include issues of indications for repeat scans.Overall: At national, regional and local levels there is a need for leadership in bone health, otherwise it will continue to be neglected and to fall between disciplines and specialties, while those at risk get less than optimal care.
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W2277188764
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Cited by: 4
Related to: 10