Thirty-minute training session reduces unnecessary ANA testing by non-rheumatologists
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Key takeaways:
- The intervention consisted of 30-minute group sessions highlighting the low specificity and false-positive risks of ANA testing.
- Departments ordered fewer tests and more results were positive.
A simple educational program on antinuclear antibody testing in non-rheumatology departments led to fewer unnecessary tests and a higher positivity rate, reflecting better patient selection, according to a study in Clinical Rheumatology.
“Antinuclear antibodies (ANAs) directed against a variety of nuclear antigens have been detected in the serum of patients with systemic autoimmune rheumatic diseases and are an important diagnostic marker for patients with systemic lupus erythematosus (SLE) and other ANA-related autoimmune diseases, such as systemic sclerosis, inflammatory myopathies, mixed connective tissue disease, and Sjögren syndrome,” Yael Pri-Paz Basson, of the rheumatology unit at Meir Medical Center, in Israel, and colleagues wrote.
“However, these antibodies may be detected in the serum of patients with nonrheumatic diseases, as well as in patients with no definable clinical syndrome,” they added. “... Inappropriate testing leads to increased health care costs and laboratory workload, as well as increased numbers of false-positive results, causing incorrect diagnoses, unnecessary patient anxiety, redundant rheumatology referrals and even inappropriate treatments.”
To reduce unnecessary ANA testing, Pri-Paz Basson and colleagues devised an educational intervention and assessed its impact in six non-rheumatology departments — one neurology and five internal medicine — at Meir Medical Center, which is affiliated with Tel Aviv University, in December 2021.
The intervention consisted of a 30-minute session in each department emphasizing use of the Choosing Wisely guidelines, as well as highlighting the ANA test’s low specificity and inapplicability as a screening tool. Department-specific information on their use of ANA testing and related outcomes were also shared. Each department’s ANA testing 6 months before the intervention was compared with that of 6 months after the training. The ratio of tests to new patients was used to assess the number of tests ordered, and the positivity rate reflected the suitability of patient selection.
After the intervention, the ratio of ANA tests to new patients decreased from 43% to 27% in the neurology department (OR = 0.49; 95% CI, 0.37-0.63) and from 2.6% to 2.2% in the internal medicine departments (OR = 0.89; 95% CI, 0.73-1.1), according to the researchers.
In addition, the percentage of positive tests rose from 43% to 53% in the neurology department post-intervention (OR = 1.49; 95% CI, 0.9-2.46), and from 48% to 59% (OR = 1.56; 95% CI, 0.99-2.44) in the internal medicine departments.
“We demonstrated that a straightforward educational intervention was associated with a decrease in the number of ANA tests ordered, as reflected by the [ratio of tests to new patients], and an improvement in patient selection, as reflected by an increase in the proportion of positive ANA test results,” Pri-Paz Basson and colleagues wrote. “The favorable outcomes found in this study demonstrate that a simple educational intervention can enhance decision-making and reduce excessive ANA testing and associated laboratory work, which in turn may lead to improved diagnostic and treatment processes.”
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