MD52S02: Antinuclear antibody test

Bottom line: Information on antinuclear antibody test was used to maintain the management of the patient (interpretation of a ‘positive’ test in a clinical context). There were no information-related patient health outcomes (no follow-up yet).

Acquisition: On September 15, 2008, MD52 did a search at home, by themselves, and before a patient encounter. They retrieved one information hit about Anti-Nuclear Antibody test (ANA). The reported search objectives were: to address a clinical question, to look up something they forgot, and to share the information with the patient. “I’m a locum in a practice, and I had gone through the morning’s blood work. That morning in the lab a requisition had come back mildly positive ANA on a patient [a 40-years old woman]. So I pulled her chart, I’ve never met her, and I realized that the physician before had ordered it because of some aches or some joint pain, or something specific to wondering whether there was an arthritis component to it. So they had ordered ANA and I got the positive results, and I was like, what do we do with that now, because everything else was normal. […] I needed to look up what the significance of that was. […] At one point, I had already looked that up, and I knew what it meant, so I just needed to remind myself. […] I will sit down with her [the patient] in a couple of weeks and explain to her that it probably wasn’t overly significant, but I just wanted to have all my information, to share with her.” According to MD52, Essential Evidence+ (EE+) was the only source for information, and the found information was relevant.

Cognition: One hit was associated with a report of positive cognitive impacts (confirmation and reassurance). “There’s been a couple times in the past where I’ve had a positive ANA on a patient with nothing else significant, and no other markers for arthritis or rheumatological problems. And usually with those folks I have just reassured and not done anything clinically about it. […] In the past, that’s how I dealt with it, and after reading the information, I felt that that, that made me feel better, that I was doing the right thing.”

Retrieved information hit(s):

1) InfoPOEMs (CIRT): ANA must be interpreted in a clinical context

Application: Information on ANA was retrieved for a patient, and was used to maintain the management of the patient (information used as presented in EE+). “It [the information] was going to be used when I sit down with the patient; […] just to educate them about the significance of that particular test.”

Outcomes: Without this information hit, MD52’s management of the patient would have been the same. There is no clear relationship between the information use and expected health outcomes. There was no follow-up (yet).

Type of path: No outcome

Acquisition	Cognition	Application	Outcomes
Address a clinical question Look up something forgotten Share information	Confirmed Reassured	Be more certain	No outcome