Diagnostic behaviour of general practitioners when suspecting Lyme disease: a database study from 2010-2015

Area of Science:

• Medical diagnostics
• General practice
• Infectious disease epidemiology

Background:

• Increased public awareness and incidence of Lyme Borreliosis (LB) have driven demand for diagnostic testing.
• This surge in demand may influence the diagnostic practices of general practitioners (GPs).

Purpose of the Study:

• To describe the diagnostic behavior of GPs when suspecting Lyme Borreliosis.

Main Methods:

• A descriptive study analyzed anonymized electronic medical records of 56,996 patients from 12 general practices in Amsterdam (January 2010-June 2015).
• An extensive search strategy identified LB-related contacts and episodes using ICPC-1 codes, free text, and diagnostic test codes.

Main Results:

• 2311 patients accounted for 3861 LB contacts and 2619 LB episodes, with seasonal peaks in spring and summer.
• Serological testing occurred in 36.4% of LB episodes, often for general symptoms (71.4%), with only 5.9% positive by immunoblot.
• Significant variation in testing rates (19.2%–75.8%) existed between practices, with no overall increase in test requests during the study period.

Conclusions:

• GPs frequently ordered serological tests for LB, contrary to guidelines, even with low clinical suspicion.
• The overuse of diagnostic tests and potential overtreatment for LB highlight the need for improved diagnostic strategies.
• Development of a user-friendly diagnostic algorithm is proposed to reduce unnecessary testing and overtreatment.