Lyme Disease Diagnosis, Treatment, and Reporting Practices Among Healthcare Providers in New Hampshire, 2014

BACKGROUND: Lyme disease (LD) is a common tick-borne disease in New Hampshire (NH). Incidence has increased significantly in the last 5-10 years, with NH recording the highest in the nation in 2012. Expert panels have published widely-accepted LD diagnosis and treatment guidelines for healthcare providers; some groups have published alternate guidelines, the extent to which they are referenced by NH providers is unknown. In 2014, the NH Department of Health and Human Services (DHHS) administered a survey to characterize knowledge, attitudes, and practices for LD among NH healthcare providers.

METHODS: A web-based survey was distributed via email to all 3,041 physicians, physician assistants, and nurse practitioners in NH’s health alert network communication system. The survey contained 47 questions on diagnosis, treatment, reporting, information sources, and patient education practices for LD. Data were analyzed and compared, where possible, to a similar survey of 296 NH physicians conducted in 1999. 

RESULTS: A total of 136 (5%) providers responded to the survey, including 89 physicians, 27 physician assistants, and 20 nurse practitioners. The majority of providers (84%) had diagnosed a patient with LD in the last year, compared to 37% in the 1999 survey (p<0.001). Most providers referred to IDSA guidelines (80%) with a small minority (4%) referring to alternative guidelines published by ILADS. To assist with the diagnosis of LD, 88% of providers reported using the recommended two-tier testing strategy, 21% reported tick testing, and 7% reported using a non-FDA approved western blot test. Sixteen percent of providers reported ever treating a patient for LD in response to a patient’s concern, even when the provider did not think the patient had LD, compared to 45% in the 1999 survey (p<0.001). Few providers (25%) reported proactively reporting LD to DHHS and instead waited for DHHS to request information following a positive laboratory test result. More than half (62%) of providers were interested in continuing education opportunities if provided by DHHS. Less than one third of providers (29%) routinely provide LD prevention information to patients.

CONCLUSIONS: Healthcare providers in NH have significant experience assessing and treating patients for LD. While limited by a poor response rate, the survey did identify important provider knowledge and practice gaps that DHHS will use to increase public and provider education through promotion of evidence-based clinical guidelines and control measures, dissemination of a state LD Prevention Plan, and targeted distribution of educational materials and training programs.