Article Figures & Data
Figures
- Figure 1. GP LD KAP survey response count by responder UK postcode area
- Figure 2. Percentage of responders (by nation), who indicated that they perceived listed regions to be high-risk for LD, alongside published regional laboratory confirmed incidence rates (cases per 100 000). aEstimated published laboratory confirmed incidence figures (cases per 100 000).5,6,25,26 bDenoted as high-risk areas in NICE guidance.12
Tables
CRN (England) SPCRN (Scotland) Social media PCDS RCGP Total Survey access count, n 326 211 609 16 12 1174 Response rate, % 33.1 25.1 5.1 6.3 0 16.4 CRN = Clinical Research Network. PCDS = The Primary Care Dermatology Society. RCGP (Royal College of General Practitioners. SPCRN = Scottish Primary Care Research Network.
Demographic Scotland survey (N = 61), %
(95% CI)Scottish national, % P-value England survey (N=130), %
(95% CI)English national, % P-value Odds ratio
(95% CI)Age band, years <31 4.9 0.6 n/a 0.8 0.6 n/a n/a 31-40 29.5 30.6 n/a 23.1 26.7 n/a n/a 41-50 36.1 34.3 n/a 40.8 34.9 n/a n/a 51-60 26.2 28.9 n/a 30.0 27.7 n/a n/a >60 3.3 5.6 n/a 5.4 10.1 n/a n/a Sex Female 73.8 61.6 0.02 53.8 56.9 0.24 n/a Relevant patient consultations in previous 3 years Tick bite 96.7
(88.65 to 99.6)n/a n/a 80.0
(72.08 to 86.5)n/a <0.001 7.38
(1.69 to 32.18)Suspected LD 93.4
(84.05 to 98.18)n/a n/a 70.8
(62.15 to 78.41)n/a <0.001 5.89
(2.0 to 17.36)Treated LD 91.8
(81.9 to 97.28)n/a n/a 63.8
(54.96 to 72.08)n/a <0.001 6.34
(2.38 to 16.94)Practice catchment area (multi-response) Rural 59.0 (45.68 to 71.45) n/a n/a 23.8 (16.81 to 32.11) n/a <0.001 4.60
(2.4 to 8.81)Urban 31.1 (19.90 to 44.29) n/a n/a 40.8
(32.24 to 49.73)n/a 0.10 0.66 (0.34 to 1.25) Suburban 11.5
(4.74 to 22.23)n/a n/a 36.2 (27.92 to 45.04) n/a <0.001 0.23
(0.09 to 0.54)n/a = value or calculation not applicable. CI = confidence interval. LD = Lyme disease.
Survey response Scotland response (N = 61), %
(95 CI)England response (N = 130), %
(95 CI)OR (95% CI) P-value Tick exposure Infected ticks may occur in green space in: (rural, suburban and urban response) 55.7 (42.45 to 68.45) 44.6 (35.9 to 53.58) 1.56 (0.85 to 2.88) 0.08 Diagnosis (True/False): correct response score False: Tick bite recall is necessary for clinical suspicion of LD 96.7 (88.65 to 99.6) 94.6 (89.22 to 97.81) 1.68
(0.34 to 8.33)0.28 False: EM appears within ≤24 hours of a tick bite 88.5 (77.77 to 95.26) 70.0 (61.34 to 77.72) 6.23
(1.41 to 27.62)<0.01 True: EM is an expanding lesion with a partial central clearing 100 (94.13 to 100) 96.9 (92.31 to 99.16) n/a n/a True: EM is sufficient for a clinical diagnosis of LD 93.4 (84.05 to 98.18) 76.2 (67.89 to 83.19) 3.89
(1.29 to 11.67)<0.01 False: EM is always present in LD 96.7 (88.65 to 99.6) 93.1 (87.26 to 96.79) 0.98
(0.09 to 10.97)0.47 True: Multiple EM may be on different areas of the body 39.3 (27.07 to 52.69) 45.4 (36.64 to 54.35) 0.74 (0.38 to 1.44) 0.19 True: EM may be located in a different area from tick bite 63.9 (50.63 to 75.84) 54.6 (45.65 to 63.36) 1.54 (0.76 to –3.12) 0.12 LD laboratory testing (True/False): correct response score False: A patient with EM should be tested for LD 63.9 (50.63 to 75.84) 26.9 (19.52 to 35.4) 4.81 (2.51 to 9.22) <0.001 LD associated signs and symptoms (multi-response) Fatigue/lethargy 100 100 a a Diffuse myalgia and arthralgia 100 99.2 a a EM 100 98.5 a a Fever 93.4 90.0 a a Arthritis 91.8 92.3 a a Cranial neuritis ± facial nerve palsy 93.4 68.5 a a Atrioventricular block 57.4 55.4 a a Provided all 7 valid responses above 55.7 47.7 a a Treatment (adult without focal symptoms — first choice treatment) Doxycycline 98.4 (91.2 to 99.96) 86.2 (79 to 91.58) 9.64 (1.26 to 74) <0.01 Duration of 21 days 83.3 (71.48 to 91.71) 57.1 (47.45 to 66.45) 3.75 (1.73 to 8.14) <0.001 Dose of 200 mg daily 80.0 (67.67 to 89.22) 56.3 (46.56 to 65.61) 3.11 (1.49 to 6.49) <0.001 Correct dose and duration 70.0 (56.79 to 81.16) 42.0 (32.7 to 51.66) 3.23 (1.66 to 6.29) <0.001 True and False response options: analysis included a ’don’t know’ response with the incorrect response option. If applicable, ’don’t know’ responses (%) for each responder group are tabulated in Supplementary Table 1. aMulti-response options may have values >100%, with no associated OR or P-value calculable. CI = confidence interval. EM = erythema migrans. LD = Lyme disease. n/a = not applicable. OR = odds ratio.
Survey response Scotland response (N = 61), % (95% CI) England response (N = 130), % (95% CI) OR
(95% CI)P-value Attitudes responses Disagreed ‘LD is a likely outcome if a person is bitten by a tick in the UK‘ 86.9 (75.78 to 94.16 81.5 (73.79 to 87.80) 1.92 (0.74 to 5.00) 0.09 Considers LD to occur within their practice region 93.4 (84.05 to 98.18) 86.9 (79.89 to 92.19) 2.14 (0.69 to 6.67) 0.09 Practice/clinical scenario Consultation with asymptomatic patient with attached and engorged tick Advise/remove tick 100 (94.13 to 100) 95.4 (90.22 to 98.29) a a Don't know response 0 3.1 (0.84 to 7.69) a a Other response 0 1.5 (0.19 to 5.45) a a Indicated method of tick removal (multi-response) Tick removal tool 96.7 (88.65 to 99.6) 89.2 (82.59 to 93.99) a a Further advice (themes from free text responses) No further advice indicated 18.0 (9.36 to 29.98) 14.6 (9.03 to 21.88) a a Prophylaxis 8.2 (2.72 to 18.1) 26.2 (18.84 to 34.58) a a Symptoms advice — EM alone 24.6 (14.46 to 37.29) 22.3 (15.48 to 30.44) a a Symptoms advice — EM and non-EM rash symptoms 55.7 (42.45 to 68.45) 40.8 (32.24 to 49.73) a a Treating a patient with a positive non-NHS approved LD test Would treat patient on basis of test 18.0 (9.36 to 29.98) 35.4 (27.2 to 44.25) a a Would not treat patient on basis of test 23.0 (13.15 to 35.5) 11.5 (6.60 to 18.32) a a Would consult guidance 41.0 (28.55 to 54.32) 47.7 (38.86 to 56.63) a a Other (free text response see Table S4a) 18.0 (9.36 to 29.98) 5.4 (2.19 to 10.78) a a Clinically manage a patient with ongoing symptoms of headache and fatigue following two courses of antibiotics for LD with EM Refer to an Infectious Disease specialist 95.1 (86.29 to 98.97) 72.3 (63.78 to 79.79) a a Discuss other possible causes for symptoms 55.7 (42.45 to 68.45) 57.7 (48.72 to 66.3) a a Discuss symptoms may not be active disease — keep under review 31.1 (19.9 to 44.29) 31.5 (23.67 to 40.27) a a Refer to other specialist 8.2 (2.72 to 18.1) 17.7 (11.56 to 25.35) a a Prescribe a third course of antibiotics for LD 4.9 (1.03 to 13.71) 1.5 (0.19 to 5.45) a a True and False response options: analysis included a ’don’t know’ response with the incorrect response option. If applicable, ’don’t know’ responses (%) for each responder group are tabulated in Supplementary Table 1. aMulti-response options may have values >100%, with no associated OR or P-value calculable. CI = confidence interval. EM = erythema migrans. LD = Lyme disease. OR = odds ratio.
Supplementary Data
- D10.3399_BJGPO.2024.0092_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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Lyme disease in UK primary care: a knowledge, attitude, and practice survey
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