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Frequency of repeat antinuclear antibody testing in Ontario: a population-based descriptive study

Lake S, Yao Z, Gakhal N, Steiman A, Hawker G, Widdifield J. CMAJ Open. 2020; 8(1):E184-90. Epub 2020 Mar 16. DOI: https://doi.org/10.9778/cmajo.20190148


Background — Repeat antinuclear antibody (ANA) testing may be unnecessary, potentially harmful and costly. Our aim was to assess the frequency and correlates of repeat ANA testing in Ontario.

Methods — We performed a retrospective descriptive study identifying ANA tests performed over 2008–2015 among adults within the Ontario Laboratories Information System. Our primary outcome was any ANA test performed within 1 year of a previous ANA test. Our secondary outcome was any repeat test after a previous positive result. Repeat testing overall (regardless of who performed the previous test) and repeat testing by the same provider who performed the previous test were determined separately. We assessed correlates of repeat testing (e.g., patient and physician characteristics) and of repeat testing after a positive result using separate logistic regression models by means of generalized estimating equations to account for clustering of repeat testing within patients and within physician practices.

Results — In total, 587 357 ANA tests were performed in 437 966 patients over the study period, of which 126 322 (21.5%) gave a positive result and 164 913 (28.1%) were repeat tests. Family physicians ordered 358 422 tests (61.0%), and rheumatologists ordered 65 071 tests (11.1%). Of the repeat tests, 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 was testing among patients with suspected or confirmed connective tissue disease.

Interpretation — Over a quarter of ANA tests 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.

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