Abstract
Our objective was to study the consumption of healthcare services and antibiotics in patients with suspicion of disseminated Lyme borreliosis (LB) before and after consultation of an infectious disease specialist. We evaluated retrospectively all presumed disseminated LB patients (n = 256) with a referral to the Department of Infectious Diseases (DID) in Helsinki University Hospital in 2013. Medical records from all healthcare providers in the area were reviewed and the number of physician contacts because of symptoms leading to LB suspicion and antimicrobial purchases were calculated 1 year before and after consultation or treatment at the DID. Patients were divided into three groups according to certainty of LB: unlikely, possible or probable/definite LB. The number of healthcare contacts 1 year before referral was higher among 121 patients with unlikely LB (6; interquartile range [IQR] 3–10), than 65 possible (4; IQR 2.5–7; p = 0.018) or 66 probable/definite LB patients (4; IQR 2.8–7; p = 0.010). The median number of contacts to healthcare during one year after consultation or treatment was 3 (IQR 0.5–7), 1 (IQR 0–3) and 0.5 (IQR 0–2.3), respectively, with a statistically significant difference between the groups (p<0.001). Antibiotics were purchased by 151 (60%) patients one year before referral and by 127 (50%) patients year after consultation or treatment at DID without statistically significant difference between groups with different LB certainty. These antibiotic purchases do not include the treatments prescribed by infectious disease specialists. In the case of 27 patients, an antimicrobial treatment was recommended in the consultation reply. In conclusion, patients with unlikely LB used more healthcare services than patients with possible or probable/definite LB. Antimicrobial consumption was similar between groups of different LB certainty.
Highlights
Lyme borreliosis (LB) is a tick-borne infectious disease affecting most often skin, nervous system and joints (Steere, 1989)
The following information was collected from medical records of Helsinki University Hospital, public healthcare centres, private health care clinics, The Finnish Student Health Service and the occupational health service of the patient: age, gender, co-morbidities, history of tick bites and erythema migrans, signs and symptoms of suspected LB, the duration of the symptoms, laboratory results, any antimicrobial treat ments between 2012 and 2017 and visits and phone calls to any physician of different healthcare providers related to symptoms leading to LB suspicion
167 (65%) patients were evaluated at the Department of Infectious Diseases and 89 (35%) re ferrals were returned with a consultation reply
Summary
Lyme borreliosis (LB) is a tick-borne infectious disease affecting most often skin, nervous system and joints (Steere, 1989). Awareness and public interest in the disease is significant and patients seek treatment from multiple healthcare providers. Over diagnosis and overtreatment of LB are related to inappropriate use of healthcare services as well as delay of crucial treatment of underlying disease and adverse events because of unnecessary antimicrobial treat ments (Goodlet and Fairman, 2018; Reid et al, 1998). In Finland, erythema migrans (EM) is mainly treated in the primary healthcare both by the public and private sectors. In the Hospital District of Helsinki and Uusimaa with 1.6 million inhabitants, general practi tioners (GPs) are guided to refer all patients with a suspicion of disseminated LB to the Department of Infectious Diseases in Helsinki University Hospital
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
