Abstract
This quality improvement study assesses whether revision of positive Lyme disease test result text was associated with decreases in the frequency of antibiotic prescriptions for patients without confirmatory results.
Highlights
476 000 individuals are treated for Lyme disease in the US annually.[1]
Before the revision of enzyme-linked immunosorbent assay (ELISA) test result text, 27% of positive ELISA test results at Atrius were treated for Lyme disease without a positive Western immunoblot (WB) result (β = –0.0007; P = .63) (Figure)
There was an immediate nonsignificant decrease in the percentage of positive ELISA test results treated without a positive WB result after the result text was changed in quarter 3 of 2015 (25% to 19%; β = –0.06; P = .05)
Summary
476 000 individuals are treated for Lyme disease in the US annually.[1] up to 50% of antibiotics prescribed for Lyme disease may be unnecessary.[2] Clinicians using the standard 2-tiered testing algorithm may overprescribe because they interpret positive enzyme-linked immunosorbent assay (ELISA) results as evidence of Lyme disease instead of waiting for the more specific Western immunoblot (WB) test to confirm the diagnosis.[3]. To encourage clinicians to wait for confirmatory WB before prescribing antibiotics, a large health care system in Massachusetts revised the reporting of positive Lyme disease ELISA test results in their electronic health record from positive to WesternToFollow in August 2015, reasoning that language indicating that testing was still in progress might decrease reflexive prescribing behavior. Our objective was to determine whether the revision of positive Lyme disease ELISA result text was associated with decreased frequency of antibiotic prescriptions for patients without confirmatory results
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