Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, Netherlands.
Department of Clinical Epidemiology, Amsterdam UMC/University of Amsterdam, Amsterdam, Netherlands.
Eur J Gen Pract. 2020 Mar 11;26(1):51-57. doi: 10.1080/13814788.2020.1732347. eCollection 2020 Dec.
Concerns are raised about missed, delayed and inappropriate diagnosis of Lyme Borreliosis. Quantitative descriptive studies have demonstrated non-adherence to the guidelines for testing for Lyme Borreliosis. To gain insight into the diagnostic practices that general practitioners apply for Lyme Borreliosis, their motives for ordering tests and how they act upon test results. A qualitative study among 16 general practitioners using semi-structured interviews and thematic content analysis. Five themes were distinguished: (1) recognising localised Lyme Borreliosis and symptoms of disseminated disease, (2) use of the guideline, (3) serological testing in patients with clinically suspect Lyme Borreliosis, (4) serological testing without clinical suspicion of Lyme Borreliosis, and (5) dealing with the limited accuracy of the serological tests. Whereas the national guideline recommends using serological tests for diagnosing, general practitioners also use them for ruling out disseminated Lyme Borreliosis. Reasons for non-adherence to the guideline for testing were to reassure patients with non-specific symptoms or without symptoms who feared to have Lyme disease, confirmation of localised Lyme Borreliosis and routine work-up in patients with continuing unexplained symptoms. Some general practitioners referred all patients who tested positive to medical specialists, where others struggled with the explanation of the results. Both diagnosis and ruling out of disseminated Lyme Borreliosis can be difficult for general practitioners. General practitioners use serological tests to reassure patients and rule out Lyme Borreliosis, thereby deviating from the national guideline. Interpretation of test results in these cases can be difficult.
人们对莱姆病的漏诊、延误和不当诊断表示担忧。定量描述性研究表明，未能遵守莱姆病检测指南。为了深入了解全科医生在莱姆病诊断方面的实践、他们进行检测的动机以及他们对检测结果的处理方式，我们进行了一项针对 16 名全科医生的定性研究，采用半结构化访谈和主题内容分析。研究区分了五个主题：（1）识别局部莱姆病和播散性疾病的症状，（2）使用指南，（3）对临床疑似莱姆病患者进行血清学检测，（4）在无临床疑似莱姆病的情况下进行血清学检测，（5）处理血清学检测的有限准确性。虽然国家指南建议使用血清学检测来诊断莱姆病，但全科医生也将其用于排除播散性莱姆病。不遵守检测指南的原因是为了安抚有非特异性症状或无症状但担心患有莱姆病的患者，确认局部莱姆病，并对持续存在不明原因症状的患者进行常规检查。一些全科医生将所有检测呈阳性的患者转介给医学专家，而其他医生则在解释结果方面存在困难。对于全科医生来说，诊断和排除播散性莱姆病都可能很困难。全科医生使用血清学检测来安抚患者并排除莱姆病，从而偏离了国家指南。在这些情况下，对检测结果的解释可能很困难。
