Bulletin 230905 — Updates to the 2023–24 Community Access Pilot
New: Antineutrophil Cytoplasmic Antibodies (ANCA) and Anti-Cyclic Citrullinated Peptide Antibodies (ACPA) testing now available at community labs
To: Ordering Clinicians (Medical Practitioners, Registered Nurses in the Extended Class, as applicable pursuant to Ontario Regulation 45/22 under the Laboratory and Specimen Collection Centre Licensing Act)
Category: Physician Services, Primary Health Care Services, Registered Nurse in the Extended Class
Written by: Laboratories & Diagnostics Branch, Health Programs and Delivery Division
Date issued: September 19, 2023
Bulletin Number: 230905
The Community Access Pilot for Laboratory Services currently extended for the 2023-24 fiscal year will now include Antineutrophil Cytoplasmic Antibodies (ANCA) and Anti-Cyclic Citrullinated Peptide Antibodies (ACPA) testing to the updated list of services. Please refer to Table 1.
These tests are available to patients at no-cost through community laboratories as of September 25, 2023
ANCA (Antineutrophil Cytoplasmic Antibodies) testing is used to diagnose ANCA-associated vasculitides – rare but serious life and organ threatening conditions.
The Community Access Pilot will now include two tests to detect ANCA: Proteinase 3 (PR3) and Myeloperoxidase (MPO) when performed using a high-quality, antigen-specific immunoassay method of ANCA detection for patients in whom there is clinical suspicion of ANCA-associated vasculitis, as per the Canadian Vasculitis Network Guidelines.
Clinicians can order these ANCA tests – Proteinase 3 (PR3) and Myeloperoxidase (MPO) if they are practicing:
- Pediatrics and all its subspecialties’
- Internal Medicine and all its subspecialties
The Community Access Pilot will not cover ANCA testing ordered by clinicians outside of this list. Clinicians outside of this list should indicate “patient-pay” on the requisition form.
ACPA (or Anti-CCP) testing
ACPA (Anti-Cyclic Citrullinated Peptide Antibodies) testing is used to diagnose Rheumatoid Arthritis. It is more specific than Rheumatoid Factor in Rheumatoid Arthritis and therefore more effective in predicting erosive disease.
Clinicians can order ACPA testing if they are practicing:
- Pediatrics and all its subspecialties
- Internal Medicine and all its subspecialties
The Community Access Pilot will not cover ACPA testing ordered by clinicians outside of this list. Clinicians outside of this list should indicate “patient-pay” on the requisition form.
Ordering Clinicians are advised not to order repeat testing:
- within 1 year if ACPA test results are negative
- if ACPA test results are positive
Table 1: Updated List of Services
|Name of Test||Collection and/or Testing||Clinical Indications for Ordering|
|Trichomonas – Nucleic Acid Amplification Test (NAAT)||Testing Only||Polymerase Chain Reaction (PCR) test (NAAT) only-no changes to existing clinical guidance.|
|Gonorrhea (NAAT)||Testing Only||PCR test (NAAT) only-no changes to existing clinical guidance.|
|Chlamydia (NAAT)||Testing Only||PCR test (NAAT) only-no changes to existing clinical guidance.|
|C. difficile-EIA stool antigen and Toxin A/B||Testing Only||Enzyme Immunoassay (EIA) as initial screen. If EIA results for antigen and toxin A/B are concordant, confirmatory NAAT is not needed.|
|C. difficile-Confirmatory (NAAT)||Testing Only||NAAT for confirmatory testing only.|
|Apolipoprotein B||Collections and Testing||As per the 2021 Canadian Cardiovascular Society (CCS) Guidelines|
|Lipoprotein a [Lp(a)]||Collections and Testing||As per the 2021 Canadian Cardiovascular Society (CCS) Guidelines|
|Celiac tissue Transglutaminase Immunoglobulin A (tTG-IgA)||Collections and Testing||For the purposes of the Pilot, should be ordered for the diagnosis of celiac disease only with the following criteria:|
|Celiac serum IgA||Collections and Testing||Used alongside Celiac tTG-IgA to determine whether a client is IgA deficient.|
|N-Terminal-pro hormone B-type Natriuretic Peptide (NT-proBNP)||Collections and Testing||Clinically indicated only in clients with suspected heart failure.|
|Antineutrophil Cytoplasmic Antibodies (ANCA): PR3 and MPO||Collections and Testing|
|Anti-Cyclic Citrullinated Peptide Antibodies (ACPA)||Collections and Testing|
For further information about the Community Access Pilot for Laboratory Services, please email CommunityLabs@ontario.ca or call 416-326-2158.
Community Access Pilot; Community Laboratories; Laboratory Services; Patient Access
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