Hackensack University Medical Centre/ Englewood Health Englewood, NJ, United States
Joel Wright and Dipal Patel, Englewood Health, Englewood, NJ
Background/Purpose: High value care must be prioritized given the rising costs associated with health care in the United States. The unwarranted testing of ANAs often contributes to a rapidly accumulating financial burden to patients and healthcare systems with further downstream testing without a beneficial change in their management or outcomes. The American College of Physicians and the American College of Rheumatology have recommended guidelines for the stepwise approach to antibody testing when CTDs are suspected. In this project we evaluate Internal Medicine Residents in their knowledge, skills and attitudes towards serologic testing, with the aim of supplementing any gaps in their practice which will ultimately enhance patient care.
Methods: A survey was developed by the researchers to identify knowledge gaps and practices of Medicine Residents regarding the ordering of ANAs. Responses of 46 residents were collected between May 16 and May 30, 2022, and the results analyzed by calculating percentages. Data analyzed included demographics, practice habits in real-life as well as simulated scenarios, and perceived comfort with the evaluation of a patient for CTD.
Results: The majority of residents (67.39%) reported that less than half of the times their patients turned out to have CTD when an ANA was ordered. On evaluating a patient for possible CTD, most (60.87%) residents would order both an ANA as well as an ENA panel whereas 17.3% would only do an ANA initially. Nine percent of residents reported always being able to interpret a positive ANA. Most residents (73.91%) would not repeat an ANA in a patient already known to have ANA positive CTD. Fifty-nine percent of residents would order an ANA for non-specific symptoms such as fatigue, myalgia and back pain. Eighty-nine percent of residents were not aware of any guidelines or recommendations for the appropriate use of ANA testing.
Conclusion: Most residents were not aware of any recommendations and had difficulty with appropriately ordering and interpreting ANA and ENA panel results based on patients' presentations. This arbitrary testing accumulates cost for patients and does not provide a concrete diagnosis which then influences their management. These findings are significant as residents comprise an important part of the healthcare workforce and will later become independent practitioners. The deficits in practice can be addressed by a curriculum focused on identification and testing of patients who have a high pretest probability of having CTD.
