Choosing wisely in daily practice: a mixed methods study on determinants of antinuclear antibody testing by rheumatologists: a mixed methods study on determinants of antinuclear antibody testing by rheumatologists

N. Lesuis, A. A. den Broeder, R. F. van Vollenhoven, J. E. Vriezekolk, Mejl Hulscher

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)


Objectives: To explore the relationship between antinuclear antibody (ANA) overuse and rheumatologist-related factors before and after an intervention aimed at reducing ANA overuse.Method: In this mixed methods study we performed surveys among rheumatologists (n=20) before and after the ANA intervention (education and feedback). We identified clinician-related determinants of ANA overuse (demographic characteristics, cognitive bias, numeracy, personality, thinking styles, and knowledge) by multivariate analysis. Two focus group meetings with rheumatologists were held 6 months after the intervention to explore self-reported determinants.Results: Questionnaires were completed by all rheumatologists and eight participated in the focus groups. Rheumatologists with more work experience and a less extravert personality ordered more ANA tests before the intervention [ = 0.01, 95% confidence interval (CI) 0.003 to 0.02, p=0.01 and = -0.11, 95% CI -0.21 to -0.01, p=0.04, respectively; R-2 = 47%]. After the intervention, female rheumatologists changed less than their male colleagues with regard to the number of ANA tests ordered ( = 0.15, 95% CI 0.03-0.26, p=0.02; R-2 = 25%). During the focus groups, seven themes were identified that influenced improvement in ANA overuse: determinants related to the intervention and the study, individual health professionals, patients, professional interactions, incentives and resources, capacity for organizational change, and social, political, and legal factors.Conclusions: We identified several determinants that together explained a sizable part of the variance observed in the ANA outcomes at baseline and in the change in ANA outcomes afterwards. Furthermore, the focus groups yielded additional factors suggesting a complex interplay of determinants influencing rheumatologists' ANA ordering behaviour
Original languageEnglish
Pages (from-to)241-246
Number of pages6
JournalScandinavian Journal of Rheumatology
Issue number3
Early online date29 Jul 2016
Publication statusPublished - 2017

Cite this