FRI0571-PC Primary care guidance for immunology testing in rheumatology: need and impact

Background Guidelines in a tertiary care Rheumatology setting showed a reduction in unnecessary immunology testing, improving efficiency and reducing expenditure (1). Objectives To assess the need for guidance for general practitioners (GPs) requesting immunology tests for patients with a potential Rheumatological diagnosis. To design guidance, implement it and assess its impact. To improve GPs’ understanding of these tests and reduce unnecessary testing. Methods An online survey was emailed to all GPs in the 49 practices in the locality regarding confidence in using immunology tests. Answers ranged from ‘Not at all confident’ to ‘Extremely confident’ on a 5-point Likert scale. Respondents stated whether they knew the cost of antibody tests and their need for teaching and online guidance. Consensus guidelines were created following collaboration between Rheumatologists, GP leads, Immunologists, and the Pathology Laboratory, based on original tertiary care guidelines (1). These were integrated into the online TQuest requesting system and emailed to GPs. Results Survey: 44 from ~200 GPs responded, giving a response rate of 23%. 2/3 of respondents felt moderately confident in choosing tests to aid diagnosis of rheumatological disease, with 40% slightly confident. There was greater variation in answers regarding confidence in choosing tests to monitor disease. None knew how much autoantibody tests cost their practice annually. 93% would appreciate teaching in this area, and 96% would appreciate online guidance. Guidance: A local face to face teaching session was arranged. We measured the number of tests requested using TQuest for 3 months prior to guidance introduction (April-June 2012), and 3 months following this (Oct–Dec 2012). Requests for rheumatoid factor (RF) underwent a steady decline, from an average of 438 in the 3 months pre-guidance, to an average of 215 in the final 3 months. Anti-CCP antibody and Complement also declined going from 2.6 to 1.6 requests and