The universe of ANA testing: a case for point-of-care ANA testing

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Abstract

Testing for total antinuclear antibodies (ANA) is a critical tool for diagnosis and management of autoimmune diseases at both the primary care and subspecialty settings. Repurposing of ANA from a test for lupus to a test for any autoimmune condition has driven the increase in ANA requests. Changes in ANA referral patterns include early or subclinical autoimmune disease detection in patients with low pre-test probability and use of negative ANA results to rule out underlying autoimmune disease. A positive result can lead to further diagnostic considerations. Currently, ANA tests are performed in centralized laboratories; an alternative would be ANA testing at the clinical point-of-care (POC). By virtue of its near real-time data collection capability, low cost, and ease of use, we believe the POC ANA has the potential to enable a new paradigm shift in autoimmune serology testing.

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Primary care physician specialty referral decision making: patient, physician, and health care system determinants.

Christopher Forrest, Paul Nutting, Sarah von Schrader … (2006)

To examine the effects of patient, physician, and health care system characteristics on primary care physicians' (PCPs') specialty referral decision making. Physicians (n=142) and their practices (n=83) located in 30 states completed background questionnaires and collected survey data for all patient visits (n=34,069) made during 15 consecutive workdays. The authors modeled the occurrence of any specialty referral, which occurred during 5.2% of visits, as a function of patient, physician, and health care system structural characteristics. A subanalysis was done to examine determinants of referrals made for discretionary indications (17% of referrals), operationalized as problems commonly managed by PCPs, high level of diagnostic and therapeutic certainty, low urgency for specialist involvement, and cognitive assistance only requested from the specialist. Patient characteristics had the largest effects in the any-referral model. Other variables associated with an increased risk of referral included PCPs with less tolerance of uncertainty, larger practice size, health plans with gate-keeping arrangements, and practices with high levels of managed care. The risk of a referral being made for discretionary reasons was increased by capitated primary care payment, internal medicine specialty of the PCP, high concentration of specialists in the community, and higher levels of managed care in the practice. PCPs' referral decisions are influenced by a complex mix of patient, physician, and health care system structural characteristics. Factors associated with more discretionary referrals may lower PCPs' thresholds for referring problems that could have been managed in their entirety within primary care settings.

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Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects

Emanuele Cozzani, Massimo Drosera, Giulia Gasparini … (2014)

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the aberrant production of a broad and heterogenous group of autoantibodies. Even though the presence of autoantibodies in SLE has been known, for more than 60 years, still nowadays a great effort is being made to understand the pathogenetic, diagnostic, and prognostic meaning of such autoantibodies. Antibodies to ds-DNA are useful for the diagnosis of SLE, to monitor the disease activity, and correlate with renal and central nervous involvements. Anti-Sm antibodies are highly specific for SLE. Anti-nucleosome antibodies are an excellent marker for SLE and good predictors of flares in quiescent lupus. Anti-histone antibodies characterize drug-induced lupus, while anti-SSA/Ro and anti-SSB/La antibodies are associated with neonatal lupus erythematosus and photosensitivity. Anti-ribosomal P antibodies play a role in neuropsychiatric lupus, but their association with clinical manifestations is still unclear. Anti-phospholipid antibodies are associated with the anti-phospholipid syndrome, cerebral vascular disease, and neuropsychiatric lupus. Anti-C1q antibodies amplify glomerular injury, and the elevation of their titers may predict renal flares. Anti-RNP antibodies are a marker of Sharp's syndrome but can be found in SLE as well. Anti-PCNA antibodies are present in 5–10% of SLE patients especially those with arthritis and hypocomplementemia.

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"I wish I had seen this test result earlier!": Dissatisfaction with test result management systems in primary care.

Thomas D. Sequist, E Poon, Rajesh Gandhi … (2004)

Failure to review and follow up on outpatient test results in a timely manner represents a patient safety and malpractice concern. Therefore, we sought to identify problems in current test result management systems and possible ways to improve these systems. We surveyed 262 physicians working in 15 internal medicine practices affiliated with 2 large urban teaching hospitals (response rate, 64%). We asked physicians about systems they used and the amount of time they spent managing test results. We asked them to report delays in reviewing test results and their overall satisfaction with their management of test results. We also asked physicians to rate features they would find useful in a new test result management system. Overall, 83% of respondents reported at least 1 delay in reviewing test results during the previous 2 months. Despite reporting that they spent on average 74 minutes per clinical day managing test results, only 41% of physicians reported being satisfied with how they managed test results. Satisfaction was associated with fewer self-reported delays in reviewing test results. Physicians who actively tracked their test orders to completion were also more likely to be satisfied. The most highly desired features of a test result management system were tools to help physicians generate result letters to patients, prioritize their workflow, and track test orders to completion. Delays in test result review are common, and many physicians are not satisfied with how they manage test results. Tools to improve test result management in office practices need to improve workflow efficiency and track test orders to completion.

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Author and article information

Contributors

Konstantin N. Konstantinov: kkonstantinov@salud.unm.edu

Robert L. Rubin: rlrubin@salud.unm.edu

Journal

Journal ID (nlm-ta): Auto Immun Highlights

Journal ID (iso-abbrev): Auto Immun Highlights

Title: Auto-Immunity Highlights

Publisher: Springer International Publishing (Cham )

ISSN (Print): 2038-0305

ISSN (Electronic): 2038-3274

Publication date (Electronic): 21 March 2017

Publication date PMC-release: 21 March 2017

Publication date Collection: December 2017

Volume: 8

Issue: 1

Electronic Location Identifier: 4

Affiliations

[1 ]ISNI 0000 0001 2188 8502, GRID grid.266832.b, Division of Rheumatology/Department of Internal Medicine, , University of New Mexico Health Sciences Center, 1 University of New Mexico, ; Mail Stop MSC10-5550, Albuquerque, NM 87131 USA

[2 ]ISNI 0000 0000 9831 362X, GRID grid.413580.b, Rheumatology Section, , Raymond G. Murphy VA Medical Center, ; 1501 San Pedro SE, Albuquerque, NM 87108 USA

[3 ]ISNI 0000 0001 2188 8502, GRID grid.266832.b, Department of Molecular Genetics and Microbiology, , University of New Mexico Health Sciences Center, 1 University of New Mexico, ; Albuquerque, NM 87131 USA

Article

Publisher ID: 93

DOI: 10.1007/s13317-017-0093-6

PMC ID: 5360668

PubMed ID: 28324325

SO-VID: 453ec203-5ef7-4256-a022-9c7cec1d1833

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 7 March 2017

Date accepted : 14 March 2017

Custom metadata

Keywords: antinuclear autoantibodies (ana),point-of-care (poc) testing,electrochemical biosensor

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Keywords: antinuclear autoantibodies (ana), point-of-care (poc) testing, electrochemical biosensor

The universe of ANA testing: a case for point-of-care ANA testing

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Most cited references 16

Primary care physician specialty referral decision making: patient, physician, and health care system determinants.

Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects

"I wish I had seen this test result earlier!": Dissatisfaction with test result management systems in primary care.

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