BONE DENSITOMETRY AT A DISTRICT GENERAL-HOSPITAL - EVALUATION OF SERVICE BY DOCTORS AND PATIENTS

Objective-To assess doctors' and patients' views about a district gene ral hospital bone densitometry service and to examine existing practic e to influence future provision. Design-Three postal surveys: (a) of d octors potentially using the service, (b) of patients undergoing a bon e densitometry rest during a six month period, and (c) of the referrin g doctors of the patients undergoing the test. Setting-Bone densitomet ry service at South Cleveland Hospital, Middlesbrough and two district health authorities: South Tees and Northallerton. Subjects-All genera l practitioners (n = 201) and hospital consultants in general medicine , rheumatology, obstetrics and gynaecoloqy, orthopaedics, radiotherapy and oncology, haematology, and radiology (n = 61); all patients under going an initial bone densitometry test (n = 309) during a sir: month period; and their referring doctors. Main measures-Service awareness a nd use, knowledge of clinical indications, test results, influence of test results on patient management, satisfaction with the service and its future provision. Results-The overall response rates for the three surveys were 87%, 70%, and 61%. There was a high awareness of the ser vice among doctors and patients; 219(84%) doctors were aware and 155 o f them (71%) had used it, and patients often (40%) suggested the test to their doctor. The test: was used for a range of reasons including s creening although the general use was consistent with current guidelin es. Two hundred (65%) bone densitometry measurements were normal, 71(2 3%) were low normal, and 38(12%) were low. Although doctors reported t hat management of patients had been influenced by the test results, th e algorithm for decision making was unclear, Patients and doctors were satisfied with the service and most (n = 146, 68%) doctors wanted ref erral guidelines for the service, Conclusions-There was a high awarene ss of, use of, and satisfaction with the service. Patients were being referred for a range of reasons and a few of these could not be justif ied, many tests were normal, and clinical decision making was not alwa ys influenced by the test result. It is concluded that bone densitomet ry services should be provided but only for patients whose management will be influenced by test results and subject to guidelines to ensure appropariate use of the technology.