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Lyme disease: Knowledge and practices of family practitioners in southern Quebec.

Ferrouillet C, Milord F, Lambert L, Vibien A, Ravel A - Can J Infect Dis Med Microbiol (2015 May-Jun)

Bottom Line: Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices.The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Groupe de recherche en épidémiologie des zoonoses et santé publique, Faculté de médecine vétérinaire, Université de Montréal, St Hyacinthe; ; Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal;

ABSTRACT

Background: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management.

Objectives: To describe FPs' clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie).

Methods: In the present descriptive cross-sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans).

Results: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%).

Conclusion: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.

No MeSH data available.


Related in: MedlinePlus

Number of different patients seen in 2011 by family physicians in three clinical situations (tick bite consultation, Lyme disease [LD] diagnosis consideration, antibiotic prescription for LD) and according to region. A All; M Montérégie; O Other
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f2-idmm-26-151: Number of different patients seen in 2011 by family physicians in three clinical situations (tick bite consultation, Lyme disease [LD] diagnosis consideration, antibiotic prescription for LD) and according to region. A All; M Montérégie; O Other

Mentions: Answers regarding clinical experience with Lyme disease are presented in Figure 2. Fifty-one percent of the respondents had never experienced a tick bite consultation, 56% had never considered a diagnosis of Lyme disease and 80% had never prescribed antibiotics for Lyme disease. Most of the respondents with clinical experience were exposed to one or two cases. The proportion of respondents who had been consulted at least once for a tick bite was higher in Montérégie than in the others regions (57% [95% CI 48% to 65%] versus 27% [95% CI 15% to 41%]). The answers regarding management of cases are presented in Table 2. In the case of a consultation for a tick bite without any symptoms or other conditions, respondents were divided between the suggested answers – 30% of them needed information to manage the case and 26% chose the right answer (absence of serology and antibiotics, education of the patient and follow-up as needed). Four percent of the respondents decided to treat patients with antibiotics, which is not a routine procedure but may be offered for prevention of Lyme disease after a recognized tick bite in an area with a prevalence of ticks infected with B burgdorferi >20%. Twenty-one percent of physicians said that they would have managed the case differently if the same patient had been bitten in a known endemic area, while 34% had no opinion. Faced with erythema migrans, 66% correctly chose to prescribe antibiotics (with or without serology), while 25% needed more information to manage the case. Respondents from Montérégie and others regions differed with regard to their answers to the tick bite and erythema migrans questions. Compared with physicians from other regions, a lower proportion of respondents from Montérégie needed information to manage the patient and a higher proportion chose an appropriate management of erythema migrans by prescribing antibiotics (with or without serology) (72% [95% CI 64% to 79%] versus 50% [95% CI 38% to 63%]).


Lyme disease: Knowledge and practices of family practitioners in southern Quebec.

Ferrouillet C, Milord F, Lambert L, Vibien A, Ravel A - Can J Infect Dis Med Microbiol (2015 May-Jun)

Number of different patients seen in 2011 by family physicians in three clinical situations (tick bite consultation, Lyme disease [LD] diagnosis consideration, antibiotic prescription for LD) and according to region. A All; M Montérégie; O Other
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507841&req=5

f2-idmm-26-151: Number of different patients seen in 2011 by family physicians in three clinical situations (tick bite consultation, Lyme disease [LD] diagnosis consideration, antibiotic prescription for LD) and according to region. A All; M Montérégie; O Other
Mentions: Answers regarding clinical experience with Lyme disease are presented in Figure 2. Fifty-one percent of the respondents had never experienced a tick bite consultation, 56% had never considered a diagnosis of Lyme disease and 80% had never prescribed antibiotics for Lyme disease. Most of the respondents with clinical experience were exposed to one or two cases. The proportion of respondents who had been consulted at least once for a tick bite was higher in Montérégie than in the others regions (57% [95% CI 48% to 65%] versus 27% [95% CI 15% to 41%]). The answers regarding management of cases are presented in Table 2. In the case of a consultation for a tick bite without any symptoms or other conditions, respondents were divided between the suggested answers – 30% of them needed information to manage the case and 26% chose the right answer (absence of serology and antibiotics, education of the patient and follow-up as needed). Four percent of the respondents decided to treat patients with antibiotics, which is not a routine procedure but may be offered for prevention of Lyme disease after a recognized tick bite in an area with a prevalence of ticks infected with B burgdorferi >20%. Twenty-one percent of physicians said that they would have managed the case differently if the same patient had been bitten in a known endemic area, while 34% had no opinion. Faced with erythema migrans, 66% correctly chose to prescribe antibiotics (with or without serology), while 25% needed more information to manage the case. Respondents from Montérégie and others regions differed with regard to their answers to the tick bite and erythema migrans questions. Compared with physicians from other regions, a lower proportion of respondents from Montérégie needed information to manage the patient and a higher proportion chose an appropriate management of erythema migrans by prescribing antibiotics (with or without serology) (72% [95% CI 64% to 79%] versus 50% [95% CI 38% to 63%]).

Bottom Line: Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices.The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Groupe de recherche en épidémiologie des zoonoses et santé publique, Faculté de médecine vétérinaire, Université de Montréal, St Hyacinthe; ; Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal;

ABSTRACT

Background: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management.

Objectives: To describe FPs' clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie).

Methods: In the present descriptive cross-sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans).

Results: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%).

Conclusion: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.

No MeSH data available.


Related in: MedlinePlus