Article Figures & Data
Tables
- Table 1. A summary of clinical cases presented to GPs (for full details see Supplementary Appendix S1)
Case Further details 1: Classic erythema migrans (EM) rash Initial presentation of EM. A photo used by multiple organisations, so GPs likely to be familiar with. Then patient revealed to have been bitten by a tick 2: Borrelial lymphocytoma Borrelial lymphocytoma of the ear lobe 3: Acrodermatitis chronica atrophicans (ACA) With associated peripheral neuropathy 4: Bell’s palsy Later revealed to have insect bite on scalp 5: Recurrent synovitis of knees None 6: Multiple EM rashes Patient had been walking in Dartmoor 7: Heart rhythm abnormalities None 8: Fatigue, post-exertional malaise, anxiety, headaches, and memory issues Later patient reveals an international lab report saying she has Lyme disease, and she demands long-term antibiotics 9: Fatigue, arthralgia, poor ability to concentrate, myalgia, mood swings None 10: Non-engorged tick attached to scalp None 11: Poor fine motor movements, rash 2 months previously at scout camp. This had been treated with erythromycin. None - Table 2. The demographics of eight GPs in the North West of England, who were interviewed to understand clinical-coding behaviour
Demographics, n =8 Mean (range) Sex, male, n 5 Mean age, years 46 (38–53) Mean time in clinical practice, years 16 (10–26) Location of practice , n LancashireMerseysideCheshire
521Time taken to complete interview, minutes 43 (20–60) I nterview cases completed , n All 11 cases10 cases2 cases 431 - Table 3. Summary of key results of a masked case-study questionnaire about coding and diagnosis regarding Lyme disease. If the case had split sections, the cells in the table are similarly split
Case (number of GPs completing it) Top three differential diagnosis, where n >2, and any mention of a Lyme disease diagnoses (number of interviews given where mentioned) Top three Read codes, where n >2, and any Lyme disease Read codes (number of interviews given where mentioned) Participant would perform further diagnostics, n Participant would prescribe drugs, n Participant would refer the case, n 1: Classic erythema migrans (EM) rash (n = 7) Lyme diseaseBite(10 differentials in total) 52 RashLyme diseaseEMSuspected Lyme disease(5 Read codes in total) 3311 5 5 5 Lyme disease(3 differentials in total) 6 2: Borrelial lymphocytoma (n = 7) No differential was mentioned more than once.(13 differentials in total) Ear swelling(5 Read codes in total, one GP wouldn’t code the case) 2 2 3 4 3: Acrodermatitis chronica atrophicans (n = 8) Alcohol-related issueVitamin B12 deficiency(19 differentials in total) 43 Peripheral neuropathySensory loss(4 Read codes in total, one GP wouldn’t code the case) 32 8 2 4 4: Bell’s palsy (n = 7) Bell’s palsyBrain tumourSpace occupying lesion(9 differentials in total) 732 Bell’s palsyNerve palsy(5 Read codes in total) 42 5 1 6 Bell’s palsyBrain tumourLyme disease(7 differentials in total) 721 5: Recurrent synovitis of knees (n = 7) OsteoarthritisRheumatoid arthritisGout(9 differentials in total) 543 Knee painSynovitis(4 Read codes in total) 32 7 7 7 6: Multiple EM rashes (n = 7) Insect biteFungal infectionLyme disease(11 differentials in total) 633 Non-specific rashErythema migrans(6 Read codes in total, one GP wouldn’t code the case) 21 3 6 0 7: Heart rhythm abnormalities (n = 7) ArrhythmiaPalpitations(11 differentials in total) 43 Palpitations(2 Read codes in total, one GP wouldn’t code the case) 5 6 2 2 8: Fatigue, post-exertional malaise, anxiety, headaches, and memory issues (n = 5) Thyroid problemsChronic fatigue syndromeDepression(8 differentials in total) 433 Tired all the time(3 Read codes in total, one GP wouldn’t code the case) 3 5 1 3 Thyroid problemsChronic fatigue syndromeDepressionLyme disease(7 differentials in total) 3221 9: Fatigue, arthralgia, poor ability to concentrate, myalgia, mood swings (n = 7) DepressionAnaemiaThyroid problems(13 differentials in total) 533 FatiguePolyarthralgia(4 Read codes in total, one GP wouldn’t code the case) 32 7 5 1 10: Non-engorged tick attached to scalp (n = 6) Cutaneous hornForeign bodySkin lesionTick(10 differentials in total) 2222 Skin lesionTick bite(4 Read codes in total) 22 4 1 0 11: Poor fine motor movements, rash 2 months previously at scout camp. This had been treated with erythromycin (n = 8) DepressionNeurological conditionLyme disease(18 differentials in total) 441 Feeling lowLow moodNeurological symptoms(4 codes in total, one GP wouldn’t code the case) 222 7 0 3
Supplementary Data
SUPPLEMENTARY MATERIALS
- bjgpopen20X101050_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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