Physician Beliefs, Attitudes, and Approaches Toward Lyme Disease in an Endemic Area

Abstract

To assess the beliefs and practice habits regarding Lyme disease among practitioners, questionnaires were sent to physicians in a seven-county Lyme-endemic region. One hundred twenty-four evaluable responses were returned from 53 family physicians, 39 pediatricians, 27 internists, and five subspecialists who diagnosed three to four cases of Lyme disease per year, on average. The majority presented with erythema migrans (EM) or other early symptoms, although arthritis was the presenting sign in 16%. The enzyme-linked immunosorbent assay (ELISA) was the most frequently ordered diagnostic test, but 45% of respondents did not specify which test when ordering Lyme serology. The majority would use amoxicillin or doxycycline to treat EM in children or adults, respectively. Nearly all would use ceftriaxone for meningitis, and half would use it to treat Lyme arthritis or Bell's palsy. Physicians differed markedly in the duration of therapy they would prescribe. Eighty-three percent would treat a patient for possible Lyme disease with antibiotics (many intravenously), even in the absence of EM or positive serology. Thirty-five percent of practitioners prescribed antibiotics for deer-tick bites. Our survey documents significant variation in approaches to Lyme disease among primary-care physicians and suggests the need for well-designed clinical trials, continuing basic research, and physician education.

Evidence-based guidelines for the management of Lyme disease

“…The IDSA and ILADS Guidelines differ substantially, revealing the wide variation in diagnosis and treatment (TABLE 1) [59,60]. This variation suggests that physicians do not use a uniform strategy to diagnose and treat Lyme disease.…”

U.S. healthcare providers’ experience with Lyme and other tick-borne diseases

“…Previous surveys focused on LD and were conducted in LD-endemic states (Eppes et al, 1994; Magri et al, 2002; Murray and Feder, 2001; Strickland et al, 1994). The goals were to determine how commonly providers see patients with tick-borne diseases, what they know about diagnosis and management of selected diseases, what their practices are with regard to post-tick bite prophylaxis, and where they obtain information regarding tick-borne diseases.…”

Community Health Nurses' Knowledge of Lyme Disease: Implications for Surveillance and Community

“…Perhaps the fact that all nurses share similar training, sit for the same licensure exams, and attend the same in-service training programs contributed to these results. Eppes et al (1994) assessed physicians' knowledge of LD and found similar understanding of LD among different medical specialties. Interestingly, our study concluded that length of service with LHD was not a factor in LD knowledge.…”

“…This is understandable when one considers the difficulties that physicians and laboratories have in consistently and accurately diagLyme Disease 9 nosing LD cases. For example, Eppes et al (1994) showed physicians were lacking knowledge about the confirmatory laboratory test for LD. Vogt's (1992) study showed inconsistencies among states in types of confirmatory laboratory testing done for LD.…”