title: Bone densitometry at a district general hospital: evaluation of service by doctors and patients.
abstract: OBJECTIVE
  To assess doctors' and patients' views about a district general hospital bone densitometry service and to examine existing practice to influence future provision.
  
  
  METHODS
  Three postal surveys: (a) of doctors potentially using the service, (b) of patients undergoing a bone densitometry test during a six month period, and (c) of the referring doctors of the patients undergoing the test.
  
  
  METHODS
  Bone densitometry service at South Cleveland Hospital, Middlesbrough and two district health authorities: South Tees and Northallerton.
  
  
  METHODS
  All general practitioners (n=201) and hospital consultants in general medicine, rheumatology, obstetrics and gynaecology, orthopaedics, radio therapy and oncology, haematology, and radiology (n=61); all patients undergoing an initial bone densitometry test (n=309) during a six month period; and their referring doctors.
  
  
  METHODS
  Service awareness and 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 service among doctors and patients; 219(84%) doctors were aware and 155 of 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 screening although the general use was consistent with current guidelines. Two hundred (65%) bone densitometry measurements were normal, 71(23%) were low normal, and 38(12%) were low. Although doctors reported that management of patients had been influenced by the test results, the algorithm for decision making was unclear. Patients and doctors were satisfied with the service and most (n=146, 68%) doctors wanted referral guidelines for the service.
  
  
  CONCLUSIONS
  There was a high awareness 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 justified, many tests were normal, and clinical decision making was not always influenced by the test result. It is concluded that bone densitometry services should be provided but only for patients whose management will be influenced by test results and subject to guidelines to ensure appropriate use of the technology.
authors.affiliation: Public Health Directorate, Tees Health Joint Administration, Middlesbrough, UK.
authors.forename: R
authors.initials: R
authors.lastname: Madhok
authors.forename: P
authors.initials: P
authors.lastname: Kirby
authors.forename: J
authors.initials: J
authors.lastname: Fordham
authors.forename: P
authors.initials: P
authors.lastname: Stamp
authors.forename: S
authors.initials: S
authors.lastname: Green
authors.forename: C
authors.initials: C
authors.lastname: Cooper
mesh_terms: D015502:Absorptiometry, Photon / Q000592:standards*; D001291:Attitude of Health Personnel; D015519:Bone Density; D004739:England; D005069:Evaluation Studies as Topic; D005194:Family Practice / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000628:therapy; D017060:Patient Satisfaction; D011446:Prospective Studies; D012017:Referral and Consultation; D013222:State Medicine / Q000592:standards; D011795:Surveys and Questionnaires