Appropriateness of laboratory tests in the diagnosis of inflammatory rheumatic diseases among patients newly referred to rheumatologists

A 1-year review of anti-Ro/La autoantibody testing in an obstetric population

OBJECTIVES

To evaluate current anti-Ro and anti-La autoantibody ordering patterns, clinical indications for performing these tests, and potential cost-benefit analysis.

METHODS

In this retrospective cohort study, patients who underwent autoantibody testing over 1 year were included. Necessary information was obtained from patient electronic records.

RESULTS

In total 47 patients underwent anti-Ro/La autoantibody testing. Of those tested, 11/47 (2%) had positive results and testing was clinically indicated in 26/47 (55%) patients, indicating minimal cost-benefits. The total rate of the cost prescription was €1644.96. The mean time to process tests was 5 days. In those with positive autoantibodies, two infants were diagnosed with congenital heart block and had pacemakers inserted after delivery.

CONCLUSION

This study found anti-Ro/La autoantibody tests were appropriately ordered in accordance with clinical guidelines. By identifying patients who were autoantibody negative, economic benefits were gained, in terms of antenatal management including reduced frequency of antenatal visits and fetal heart surveillance.

Mitigating overuse of antinuclear antibody (ANA) testing through educational intervention: a study in internal medicine and neurology departments

INTRODUCTION/OBJECTIVES

Overuse of antinuclear antibody (ANA) tests leads to increased costs, false positives, and unnecessary treatments. This study evaluated ANA overuse in internal medicine and neurology departments and assessed the impact of an educational intervention.

METHOD

This quality improvement educational intervention study examined ANA test overuse in five internal medicine departments and one neurology department at a university-affiliated medical center. The educational intervention included a session focusing on ANA testing appropriateness. Outcome measures comprised the ANA/new patient ratio (APR) and the percentage of positive ANA test results. Outcomes were compared between the pre- and post-intervention periods (both 6 months).

RESULTS

The intervention took place in December 2021. The APR decreased from 43% in the pre-educational intervention period to 27% in the post-intervention period in the neurology department (odds ratio [OR] 0.49, confidence interval [95% CI] 0.37-0.63, P < 0.0001) and from 2.6% to 2.2% in the internal medicine departments (OR 0.89, 95% CI 0.73-1.10, P = 0.28). The percentage of positive ANA tests increased from 43% pre-intervention to 53% in the post-intervention period (OR 1.49, 95% CI 0.90-2.46, P = 0.12) in the neurology department and from 48% to 59% (OR 1.56, 95% CI 0.99-2.44, P = 0.0543) in the internal medicine departments.

CONCLUSION

A simple educational intervention reduced unnecessary ANA testing in the neurology department but not in internal medicine departments, improving patient selection and potential cost savings. The results underscore the importance of targeted education to promote evidence-based behavior among healthcare professionals. Further research with longer follow-up is needed to assess the sustainability of these improvements.