Patients with suspected or confirmed connective tissue disease were significantly more likely than those without such a diagnosis to undergo repeat testing within 12 months (OR 2

Patients with suspected or confirmed connective tissue disease were significantly more likely than those without such a diagnosis to undergo repeat testing within 12 months (OR 2.20, 95% CI 2.01C2.41 for any physician; OR 3.08, 95% CI 2.70C3.51 for the same physician). result and 164 913 (28.1%) were repeat tests. Family physicians ordered 358 422 assessments (61.0%), and rheumatologists ordered 65 071 assessments (11.1%). L-Valyl-L-phenylalanine Of the repeat assessments, 82 332 (49.9%) were ordered within 12 months of the previous test. Among the 73 961 repeat tests ordered by the same practitioner within 12 months, the previous test result was positive for 22 657 (30.6%). A higher proportion of rheumatologists than other physicians ordered repeat tests within 12 months (36.1% v. 11.3%). The most significant correlate of potentially redundant testing Rabbit Polyclonal to OR5B12 was testing among patients with suspected or confirmed connective tissue disease. Interpretation: Over a quarter of ANA assessments in Ontario were repeat tests; rheumatologists were most likely to order repeat testing. Our findings may be useful to inform quality-improvement initiatives related to the appropriateness of ANA testing. Laboratory testing is the highest-volume medical procedure, 1 and volumes are increasing annually.2,3 It has been estimated that 20% of assessments are ordered unnecessarily.4,5 Misuse of laboratory tests is a major challenge affecting the sustainability of health care.6,7 Improving the appropriateness of rheumatology laboratory L-Valyl-L-phenylalanine testing is a priority of Choosing Wisely campaigns.8,9 Concerns have been raised about the inappropriate use of antinuclear antibody (ANA) testing. Testing for ANA is usually indicated only if L-Valyl-L-phenylalanine a patients clinical history and physical examination show symptoms or signs suggestive of systemic lupus erythematosus, scleroderma, Sj?gren syndrome, polymyositis or dermatomyositis.10,11 The test has high sensitivity, and, thus, a positive test result can contribute to a diagnosis of these conditions. 12 However, it has low specificity, and ANA and can be seen in other conditions and in more than 20% of healthy people, 13 which makes interpretation of test results challenging.12 Choosing Wisely Canada recommends that ANA testing should not be used to screen subjects without specific symptoms or without a clinical evaluation that may lead to a diagnosis of systemic L-Valyl-L-phenylalanine lupus or other connective tissue disease.8 International recommendations strongly advise that ANA testing is usually primarily intended for diagnostic purposes, and not for monitoring disease progression owing to its limited value in monitoring disease activity.14C17 Thus, it is not appropriate to repeat ANA following a positive test result.7C9,16,18 Inappropriate testing may cause patients confusion and anxiety, and lead to overdiagnosis, overtreatment, and unnecessary consultations and costs.19C23 Moreover, given the rare incidence of systemic autoimmune rheumatic diseases24C26 and previous research suggesting that ANA assessments are often ordered serially or in settings of low pretest probability,19,27,28 understanding patterns of ANA testing is useful to inform quality-improvement initiatives assessing the appropriateness of ANA testing. Therefore, our aim in the present study was to assess the frequency and correlates of repeat ANA testing. Methods We performed a retrospective study over 2008C2015 using health administrative databases in Ontario. Sources of data We identified ANA assessments (including dates, test results and ordering physician) using Logical Observation Identifiers Names and Codes from the Ontario Laboratories Information System, a nearly population-wide database of laboratory test results in Ontario. The Ontario Laboratories Information System captures both community and hospital laboratory assessments. At the time of analysis, the period of laboratory data spanned from Jan. 1, 2007, to Sept. 30, 2015, and the provincial coverage increased from 41% in 2008 to 71% in 2009 2009, 86% in 2010 2010 and 99% in 2014. We linked patients with ANA assessments performed between 2008 and 2015 to the Ontario Health Insurance L-Valyl-L-phenylalanine Plan Claims Database to identify diagnoses (according to a modification of the = 18 170) or lived out of province (= 562). The remaining 28 patients were excluded owing to invalid health card numbers and death occurring on the date of the index test. Testing-level results In total, 587 357 ANA assessments were performed over the study period, of which 164 913 (28.1%) were repeat tests during the study period and 82 332 (14.0%) were repeat tests within 12 months of a previous test (Table 1). Of the 587 357, 126 322 (21.5%) gave a positive result. Table 1: Frequency of total.