Abstract
BackgroundOsteoporosis creates brittle bones susceptible to fracture, with resulting high levels of morbidity and mortality. Poor access to bone densitometry services for the residents of North Wales led to the Welsh Assembly Government offering capital to purchase a dual-energy X-ray absorptiometry (DXA) scanner, used to diagnose osteoporosis, for the region. The commissioning question for the six Local Health Boards across North Wales was where to site the new scanner. This decision needed to reflect current inequalities in access to services and concerns over inappropriate prescribing relative to Welsh norms.MethodsEpidemiological, corporate and comparative healthcare needs assessments were performed. In addition, two cross-sectional surveys were conducted to determine the views of general practices and users of bone densitometry services resident in North Wales. An option appraisal and sensitivity analysis of 13 costed options for DXA scanning was conducted.ResultsWe estimated that only 31% of the people in North Wales who met national guidelines were receiving DXA scans. There was definite inequity of access to the current service provided by area of residence. There was also evidence of inequity of access by age and sex. The most suitable option identified in the option appraisal was a bone densitometry service based in the central location of Llandudno.ConclusionThe assessment identified significant unmet need for DXA scanning. A recommendation was made to improve access through the introduction of a new bone densitometry service based at Llandudno. This would double scanning provision provided and reduce travel costs and time for many North Wales residents. This recommendation was adopted by a joint commissioning group established by the six Local Health Boards in North Wales at the end of 2004 – evidence based commissioning in practice.
Highlights
Osteoporosis creates brittle bones susceptible to fracture, with resulting high levels of morbidity and mortality
There are other methods available for measuring bone density such as quantitative ultrasound (QUS) and peripheral dual-energy X-ray absorptiometry, central DXA is recognised as the gold-standard diagnostic technique because of its flexibility to assess different skeletal sites, its high reproducibility and its low radiation dose [3]
More than one quarter of practices in North Wales reported that they had had at least one patient in the last 12 months who had refused or been unable to travel to Gobowen because of travel distance
Summary
Osteoporosis creates brittle bones susceptible to fracture, with resulting high levels of morbidity and mortality. Poor access to bone densitometry services for the residents of North Wales led to the Welsh Assembly Government offering capital to purchase a dual-energy X-ray absorptiometry (DXA) scanner, used to diagnose osteoporosis, for the region. The commissioning question for the six Local Health Boards across North Wales was where to site the new scanner This decision needed to reflect current inequalities in access to services and concerns over inappropriate prescribing relative to Welsh norms. There are other methods available for measuring bone density such as quantitative ultrasound (QUS) and peripheral dual-energy X-ray absorptiometry (pDXA), central DXA is recognised as the gold-standard diagnostic technique because of its flexibility to assess different skeletal sites, its high reproducibility and its low radiation dose [3]. QUS and pDXA measure sites on the peripheral skeleton (usually heel and/or forearm) while central DXA measured sites on the central skeleton (e.g. spine and hip)
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