Reply

N. Erb1,, R. Duncan2, K. Raza3, I. F. Rowe4, G. D. Kitas1,3, R. D. Situnayake5 and West Midlands Rheumatology Services and Training Committee

1 Dudley Group of Hospitals NHS Trust, Department of Rheumatology, Dudley,
2 University Hospital Birmingham NHS Trust, Selly Oak Hospital, Department of Rheumatology, Birmingham,
3 The University of Birmingham Medical School, Department of Rheumatology, Birmingham,
4 Worcestershire Acute Hospitals NHS Trust, The Highfield Rheumatology Unit, Worcester and
5 The City Hospital NHS Trust, Department of Rheumatology, Birmingham, UK

Osteoporosis, as stated by Miah et al., is a major public health problem and we were encouraged to see that our audit on the prevention and management of corticosteroid-induced osteoporosis (CIOP) has stimulated interest in the rheumatology community. The audit performed by Miah et al. at the Gartnavel Hospital in Glasgow produced similar results to the West Midlands Regional Audit on corticosteroid-induced osteoporosis. When using the National Osteoporosis Society guidance, Miah et al. found a higher proportion of patients appropriately treated in Gartnavel Hospital compared with the West Midlands audit (73 and 63% respectively). We disagree that these results are encouraging, as significant proportions of patients are inadequately treated in both units (37% in the West Midlands audit and 27% in Gartnavel Hospital). The audit standard in the West Midlands audit was set at 80% of appropriately treated patients, which both audits failed to achieve. However, these are the first results of such audits to be published in the rheumatological press, and therefore do provide baseline figures to audit against. We hope that this work will encourage more rheumatology units to assess their practice in this important area, and that more correspondence will be seen as the audit cycle is completed and treatment is reassessed.

Miah et al. have only looked at a small number of patients from one rheumatology unit, which could limit the generalizability of the results. The West Midlands Rheumatology Services and Training Committee (WMRSTC) decided to carry out a regional audit to overcome this problem, and the West Midlands Regional Audit looked at 1766 patients in 10 rheumatology units. Interestingly, the results from the 10 units were very variable and led to the reassessment of CIOP management in a number of the participating units.

Miah et al. collected more data on each individual patient than the West Midlands audit. This additional information is useful when using the Royal College of Physicians guidelines on the prevention and management of osteoporosis. However, there is a trade-off with all guidelines, in that as the amount of information required on each individual in order to follow algorithms increases, the speed and ease of use of the guidelines declines. The Royal College of Physicians guidelines also suggest that 100% of patients at risk of osteoporosis have a dual X-ray absorptiometry (DEXA) scan. Both audits failed to reach this target, but the results in the West Midlands audit were particularly poor, only 43.4% of patients at risk having had a DEXA scan. Access to DEXA scanning is limited in the West Midlands, and the results of the West Midlands audit have been used by a number of units in the development of their DEXA services. This illustrates how an audit can highlight deficiencies in facilities and services. We would encourage rheumatology units to continue to audit CIOP and other areas of clinical practice to set, monitor and improve standards of clinical care.

Notes

Correspondence to: N. Erb, Department of Rheumatology, The Guest Hospital, Tipton Road, Dudley, West Midlands DY1 4SE. E-mail: Nicola.Erb{at}dudleygoh-tr.wmids.nhs.uk Back

Accepted 23 January 2003





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