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

doi:10.1093/eurpub/ckac013

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

Eur J Public Health. 2022 Jun 1;32(3):436-442. doi: 10.1093/eurpub/ckac013.

Authors

Fredrikke Christie Knudtzen^{1

2

3}, Thøger Gorm Jensen^{1

4}, Nanna Skaarup Andersen^{1

5}, Isik Somuncu Johansen^{2

3}, Joppe W Hovius⁶, Sigurdur Skarphédinsson^{1

2

3}

Affiliations

¹ Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.
² Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
³ Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
⁴ Department of Clinical Microbiology, Odense University Hospital and Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark.
⁵ Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark.
⁶ Amsterdam UMC, Location AMC, Center for Experimental and Molecular Medicine, Amsterdam Multidisciplinary Lyme Borreliosis Center, University of Amsterdam, Amsterdam, The Netherlands.

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.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Borrelia*
Denmark / epidemiology
General Practice*
Humans
Lyme Disease* / diagnosis
Lyme Disease* / epidemiology
Lyme Disease* / therapy
Lyme Neuroborreliosis* / diagnosis
Lyme Neuroborreliosis* / epidemiology
Lyme Neuroborreliosis* / therapy
Prospective Studies

Associated data

ClinicalTrials.gov/NCT03820999