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Knight KJ, Fordham RJ, Crabtree NJ, Knapp KM. Evaluating the impact of COVID-19 on DXA waiting lists and osteoporosis prescription trends in England 2019-2023. Osteoporos Int 2024:10.1007/s00198-024-07120-6. [PMID: 38795142 DOI: 10.1007/s00198-024-07120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/03/2024] [Indexed: 05/27/2024]
Abstract
This study uses NHS waiting times and osteoporosis medication community prescription datasets to assess the impact of COVID-19 on DXA waits and osteoporosis medication patterns in England. Results show significant increases in DXA waiting list times and variation in prescription rates. Investment is needed to improve waiting list times. PURPOSE This study investigates the impact of COVID-19 on DXA scan waiting lists, service recovery and osteoporosis medication prescriptions in the NHS following the March 2020 national lockdowns and staff redeployment. METHODS Data from March 2019 to June 2023, including NHS digital diagnostics waiting times (DM01) and osteoporosis medication prescriptions from the English Prescribing Dataset (EPD), were analysed. This encompassed total waiting list data across England's seven regions and prescribing patterns for various osteoporosis medications. Analyses included total activity figures and regression analysis to estimate expected activity without COVID-19, using R for all data analysis. RESULTS In England, DXA waiting lists have grown significantly, with the yearly mean waiting list length increasing from 31,851 in 2019 to 65,757 in 2023. The percentage of patients waiting over 6 weeks for DXA scans rose from 0.9% in 2019 to 40% in 2020, and those waiting over 13 weeks increased from 0.1% in 2019 to 16.7% in 2020. Prescription trends varied, with increases in denosumab, ibandronic acid and risedronate sodium and decreases in alendronic acid, raloxifene hydrochloride and teriparatide. A notable overall prescription decrease occurred in the second quarter of 2020. CONCLUSION COVID-19 has significantly increased DXA scan waiting lists with ongoing recovery challenges. There is a noticeable disparity in DXA service access across England. Osteoporosis care, indicated by medication prescriptions, also declined during the pandemic. Addressing these issues requires focused investment and effort to improve DXA scan waiting times and overall access to osteoporosis care in England.
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Affiliation(s)
- K J Knight
- Department of Health and Care Professions, Faculty of Health and Life Sciences, Medical Imaging, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX12 2lU, UK.
| | - R J Fordham
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - N J Crabtree
- Birmingham Women's and Children's NHS Trust and Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - K M Knapp
- Department of Health and Care Professions, Faculty of Health and Life Sciences, Medical Imaging, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX12 2lU, UK
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Kocijan R, Stockinger T, Haschka J, Reichardt B, Resch H, Zwerina J, Behanova M. Dispensing anti-osteoporotic drugs changed during the COVID-19 pandemic. Bone 2022; 162:116477. [PMID: 35779846 PMCID: PMC9239920 DOI: 10.1016/j.bone.2022.116477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/27/2022] [Accepted: 06/25/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Caring for osteoporosis patients has proven challenging during the COVID-19 pandemic due to repeated lockdowns in Austria. The distinct possibility of insufficient treatment regimens is therefore a matter of pressing concern. The aim of the study was to assess alterations in dispensing anti-osteoporotic drugs during the COVID-19 pandemic. PATIENTS/METHODS This study was a nationwide retrospective register-based observational study which included all patients in Austria aged ≥50 who received at least one prescription for anti-osteoporotic medication between January 2016 and November 2020. Pseudonymised individual-level patients' data were obtained from social insurance authorities. Anti-osteoporotic agents were divided into: (i) oral bisphosphonates, (ii) intravenous bisphosphonates, (iii) selective estrogen receptor modulators (SERMs), (iv) teriparatide (TPTD) and (v) denosumab (DMAB). We used interrupted time series analysis with autoregressive integrated moving average models (ARIMA) to predict drug dispensing. RESULTS There were 2,884,374 dispensations of anti-osteoporotic drugs to 224,598 patients between 2016 and 2020. The mean monthly prescriptions for oral bisphosphonates (-14.5 %) and SERMs (-12.9 %) decreased during the COVID-19 pandemic when compared to the non-COVID-19 period. Dispensing for intravenous bisphosphonates (1.7 %) and teriparatide (9.5 %) increased. Prescriptions for DMAB decreased during the first lock-down, however increased by 29.1 % for the total observation time. The Arima models showed that in March 2020 (beginning of the 1st COVID-19 lockdown), there was a decrease of 778 dispensings, with a further increase of 14 dispensings every month for denosumab; a decrease by 178 dispensings, with a further increase of 23 dispensings every month for zolendronic acid; a decrease by 2950 dispensings, but with a further increase of 236 dispensings every other month for ibandronate and a decrease by 1443 dispensing with a further decrease of 29 dispensings for alendronate than predicted, had the lockdown not occurred. CONCLUSIONS The total number of prescriptions dispensed to patients treated with anti-osteoporotic medications declined rapidly during first COVID-19 lockdown. The observed decrease of DMAB during the first lockdown rebounded in the following months. Considering the massive treatment gap for osteoporosis, and the related fracture risk, clinicians should continue treatment, even during a pandemic.
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Affiliation(s)
- Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; Sigmund Freud University Vienna, School of Medicine, Metabolic Bone Diseases Unit, Vienna, Austria
| | - Theresa Stockinger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; Sigmund Freud University Vienna, School of Medicine, Metabolic Bone Diseases Unit, Vienna, Austria
| | - Judith Haschka
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Berthold Reichardt
- Austrian Social Health Insurance Fund, Österreichische Gesundheitskasse, Eisenstadt, Austria
| | - Heinrich Resch
- Sigmund Freud University Vienna, School of Medicine, Metabolic Bone Diseases Unit, Vienna, Austria; St. Vincent Hospital Vienna, 2nd Department of Internal Medicine, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Martina Behanova
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria.
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Pinson JA, Diep ML, Krishnan V, Aird C, Cooper C, Leong C, Chen J, Ardley N, Paul E, Badawy MK. Imaging volumes during COVID-19: A Victorian health service experience. World J Radiol 2022; 14:293-310. [PMID: 36160832 PMCID: PMC9453320 DOI: 10.4329/wjr.v14.i8.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/07/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The World Health Organisation declared the coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. While globally, the relative caseload has been high, Australia’s has been relatively low. During the pandemic, radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.
AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.
METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves. Weekly volumes across patient class, modality and mobile imaging were summed for periods: wave 1 (weeks 11 to 16 for 2019; weeks 63 to 68 for 2020) and wave 2 (weeks 28 to 43 for 2019; weeks 80 to 95 for 2020). Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.
RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8% in adult outpatient imaging volumes and 46.3% in paediatric emergency department imaging volumes. Adult nuclear medicine demonstrated the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 47.8%, with angiography increasing by 50%. The pandemic’s second wave demonstrated the greatest decrease of 23.5% in adult outpatient imaging volumes, with an increase of 18.2% in inpatient imaging volumes. The greatest decrease was 28.5% in paediatric emergency department imaging volumes. Nuclear medicine showed the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 36.7%. Mobile imaging utilisation increased between 57.8% and 135.1% during the first and second waves. A strong correlation was observed between mobile and non-mobile imaging in the emergency setting (Spearman’s correlation coefficient = -0.743, P = 0.000). No correlation was observed in the inpatient setting (Spearman’s correlation coefficient = -0.059, P = 0.554).
CONCLUSION Nuclear medicine was most impacted, while computed tomography and angiography were the least affected by the pandemic. The impact was less during the pandemic’s second wave. Mobile imaging shows continuous growth during both waves.
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Affiliation(s)
- Jo-Anne Pinson
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
- Department of Medical Imaging, Peninsula Health, Melbourne, Victoria 3099, Australia
- Department of Medical Imaging and Radiation Sciences, School of Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - My Linh Diep
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
| | - Vinay Krishnan
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
| | - Caroline Aird
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
| | - Cassie Cooper
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
| | - Christopher Leong
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
| | - Jeff Chen
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
| | - Nicholas Ardley
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3800, Australia
| | - Mohamed Khaldoun Badawy
- Monash Health Imaging, Monash Health, Clayton, Victoria 3168, Australia
- Department of Medical Imaging and Radiation Sciences, School of Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
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Hampson G, Stone M, Lindsay JR, Crowley RK, Ralston SH. Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance. Calcif Tissue Int 2021; 109:351-362. [PMID: 34003337 PMCID: PMC8129963 DOI: 10.1007/s00223-021-00858-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022]
Abstract
It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.
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Affiliation(s)
- G Hampson
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, Lambeth Palace Road, 5th Floor, North Wing, London, SE1 7EH, UK.
- Department of Rheumatology, Metabolic Bone Clinic, Guy's Hospital, London, UK.
| | - M Stone
- Metabolic Bone Service, University Hospital Llandough, Llandough, Penarth, CF64 2XX, UK
| | - J R Lindsay
- Osteoporosis and Bone Metabolism Service, Musgrave Park Hospital, Belfast, Northern Ireland, UK
| | - R K Crowley
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - S H Ralston
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
- Rheumatic Diseases Unit, NHS Lothian Western General Hospital Edinburgh, Edinburgh, EH4 2XU, UK
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