An intervention in general practice to improve the management of Lyme borreliosis in Denmark

Fredrikke Christie Knudtzen, Thøger Gorm Jensen, Nanna Skaarup Andersen, Isik Somuncu Johansen, Joppe W Hovius, Sigurdur Skarphédinsson, Fredrikke Christie Knudtzen, Thøger Gorm Jensen, Nanna Skaarup Andersen, Isik Somuncu Johansen, Joppe W Hovius, Sigurdur Skarphédinsson

Abstract

Background: Our objectives were to improve the following outcomes in patients with Lyme borreliosis (LB) through an educational intervention in general practice: (i) increase the number of hospital referrals on suspicion of LB, (ii) increase the number of cerebrospinal fluid (CSF) tests examined for Borrelia burgdorferi antibody index, (iii) decrease the number of serum-B. burgdorferi antibody tests ordered, (iv) shorten delay from symptom onset to hospital in Lyme neuroborreliosis (LNB) patients, (v) increase LB knowledge among general practitioners.

Methods: A prospective non-blinded non-randomized intervention trial on the island of Funen, Denmark. The intervention included oral and written education about LB and was carried out in areas with an LNB incidence ≥4.7/100.000 between 22 January 2019 and 7 May 2019. Results were compared between the intervention group (49 general practices) and the remaining general practices in Funen (71 practices) 2 years before and after the intervention.

Results: In the study period, 196 patients were referred on suspicion of LB, a 28.9% increase in the intervention group post-intervention, 59.5% increase in the control group (P = 0.47). The number of CSF-Borrelia-antibody index tests increased 20.8% in the intervention group, 18.0% in the control group (P = 0.68), while ordered serum-B. burgdorferi antibody tests declined 43.1% in the intervention group, 34.5% in the control group (P = 0.30). 25.1% had the presence of serum-B. burgdorferi antibodies. We found no difference in LNB pre-hospital delay before and after intervention or between groups (P = 0.21). The intervention group performed significantly better on a follow-up questionnaire (P = 0.02).

Conclusion: We found an overall improvement in LB awareness and referrals among general practitioners but could not show any effect of the intervention on clinical outcomes of LNB.

Trial registration: ClinicalTrials.gov NCT03820999.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.

Figures

Figure 1
Figure 1
Map of the island of Funen, Langeland and Ærø. Divided by postal codes into areas with a Lyme neuroborreliosis incidence of ≥4.7/100.000 population per year, where general practices were eligible for inclusion (dark blue), and areas with Lyme neuroborreliosis incidence

Figure 2

Flow chart of inclusion of…

Figure 2

Flow chart of inclusion of general practices into an educational intervention about ticks…

Figure 2
Flow chart of inclusion of general practices into an educational intervention about ticks and tick-borne infections on the islands of Funen, Langeland and Ærø.
Figure 2
Figure 2
Flow chart of inclusion of general practices into an educational intervention about ticks and tick-borne infections on the islands of Funen, Langeland and Ærø.

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