Rheumatologists and the Requesting of Antinuclear Antibodies (ANA) Tests in Patients With Rheumatologic Complaints

Study Overview
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Brief Summary
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The aim of this study is to assess the effect of a simple intervention (a combination of education and feedback) on Antinuclear Antibody (ANA) testing. This aim was chosen because of the known overuse of many laboratory tests, of which ANA testing is one. As overuse of ANA tests can have negative consequences (both for patients and society), the investigators designed an intervention to see how this would influence Antinuclear Antibody testing by rheumatologists.

Official Title
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Requesting Behaviour of Rheumatologists Regarding Antinuclear Antibodies (ANA) in Patients With Rheumatologic Complaints

Conditions
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Rheumatic Diseases

Intervention / Treatment
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* Behavioral: Education and feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria rheumatologists: rheumatologists who are consulting patients at the rheumatology outpatient clinic of a participating centre Exclusion Criteria rheumatologists: rheumatologists not working the full study period (pre- and post-intervention) at a participating centre rheumatologists not giving their consent to participate Inclusion Criteria patients - all patients with an ANA test requested by an included rheumatologist during the study period Exclusion Criteria patients - patients with an ANA test requested during a clinical admission
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Education and feedback<br>The intervention consisted of a one-hour, small group educational session. During this session information on rational ANA testing was provided and feedback on current ANA testing was provided to the rheumatologists. A booster session with the same components was held 6 months after the first session. | Behavioral: Education and feedback<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline (pre-intervention) ANA/new patient ratio (APR) at 12 months (post-intervention) | Number of ANA tests divided by the number of new patients | Pre- and post-intervention (both 12 months) | 
| Change from baseline (pre-intervention) % of positive ANA tests at 12 months (post-intervention) | Percentage of ANA tests reported as positive by the local laboratory. ANA tests reported as 'weakly positive' are regarded as negative. | Pre- and post-intervention (both 12 months) | 
| Change from baseline (pre-intervention) % of repeated ANA testing at 12 months (post-intervention) | Percentage of patients with ≥1 ANA test in 12 months (pre- or post-intervention period) | Pre- and post-intervention (both 12 months) | 
| Change from baseline (pre-intervention) % of ANA associated diagnoses at 12 months (post-intervention) | Percentage of patients, in which an ANA is done during the study period, with final diagnosis of SLE, SSc, PM/DM, MCTD or SS | Pre- and post-intervention (both 12 months) | 
| Change from baseline (pre-intervention) APR variation between rheumatologists at 12 months (post-intervention) | Standard deviation around the mean APR, calculated from the APRs of the individual rheumatologists | Pre- and post-intervention (both 12 months) | 
| Change from baseline (pre-intervention) reaching the of target APR at 12 months (post-intervention) | Difference (percentage) between the actual APR and the target-APR defined during the intervention | Pre- and post-intervention (both 12 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rheumatologists, Quality of care, Overuse, Antinuclear antibody (ANA)