Consumption of healthcare services and antibiotics in patients with presumed disseminated Lyme borreliosis before and after evaluation of an infectious disease specialist

Elisa Kortela; Mari J Kanerva; Satu Kurkela; Jarmo Oksi; Mari Koivisto; Asko Järvinen

doi:10.1016/j.ttbdis.2021.101854

Consumption of healthcare services and antibiotics in patients with presumed disseminated Lyme borreliosis before and after evaluation of an infectious disease specialist

Ticks Tick Borne Dis. 2022 Jan;13(1):101854. doi: 10.1016/j.ttbdis.2021.101854. Epub 2021 Oct 9.

Authors

Elisa Kortela¹, Mari J Kanerva², Satu Kurkela³, Jarmo Oksi⁴, Mari Koivisto⁵, Asko Järvinen²

Affiliations

¹ Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland. Electronic address: elisa.kortela@hus.fi.
² Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
³ Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁴ Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland.
⁵ Department of Biostatistics, University of Turku, Turku, Finland.

PMID: 34695770
DOI: 10.1016/j.ttbdis.2021.101854

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.

Keywords: Antibiotics; Borrelia burgdorferi sensu lato; Consumption of healthcare services; Finland; Healthcare; Lyme borreliosis.

Publication types

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

MeSH terms

Anti-Bacterial Agents / therapeutic use
Borrelia burgdorferi*
Communicable Diseases* / drug therapy
Delivery of Health Care
Humans
Lyme Disease* / diagnosis
Lyme Disease* / drug therapy
Lyme Disease* / epidemiology
Physicians*
Retrospective Studies

Substances

Anti-Bacterial Agents