Positive ANA referrals to rheumatology clinic : utility of triage system into telemedicine clinics

Abstract

Introduction A significant shortage of rheumatologists exists at MU Healthcare nationwide, with positive antinuclear antibody (ANA) being the most common reason for referrals to rheumatology. However, most of these patients do not have inflammatory rheumatic disease. To address this issue, the MU Rheumatology Clinic implemented a triage system, involving prescreening medical records and scheduling most of the positive ANA referrals for telemedicine appointments. This study assesses the triage system’s effectiveness in assigning new patients with low likelihood of rheumatologic disease to telehealth visits. Methods This study records of patients referred for positive ANA results and scheduled for telemedicine appointments at our clinic between January 1, 2022 and December 31, 2022. We recorded eventual diagnoses made at the rheumatology clinic and whether the patient required in person follow up. Results A large majority of the patients (125 out of 135, 93%) were found to have non-inflammatory conditions that are not necessarily managed by rheumatologists and do not require immunosuppressive therapy. ANA values ranged from 1:40 to 1:1280, showing no clear correlation between higher ANA and increased risk of inflammatory rheumatic disease. Conclusion Our results indicate the high accuracy of the MU rheumatology triage system in assigning new patient referrals with a low risk of inflammatory rheumatic disease to telehealth appointments. Adoption of universal rheumatology clinic triage systems for new patient referrals may reduce inappropriate utilization of clinic resources and physician burden.