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Consultation in out-of-hours practice: a clinical review of Lyme disease

02 December 2022
Volume 33 · Issue 12


In this article Sharon Brydon and Dr Sonya MacVicar highlight the importance of reaching a shared decision with the patient understanding the perceived risk and benefits of treatment

In recent times, telephone triage and virtual consultation have been expedited in the out-of-hours urgent primary care setting. This brings challenges concerning gaining a comprehensive history and building a therapeutic relationship between nurse prescriber and patient. This article presents a clinical review of Lyme disease to explore consultation models and how implementing a hybrid consultation approach may support the practitioner to develop safe prescribing practices and optimise patient expectations. This review of Lyme disease management highlights the sparse, low-quality evidence available, with national guidance indicating antimicrobial treatment for those who present with an erythema migrans rash prior to laboratory testing confirmation. This reinforces the importance of reaching a shared decision with the patient understanding the perceived risk and benefits of treatment. The factors discussed include Lyme disease prevention and how the practitioner ensures safety netting in the out-of-hours setting.

Undertaking an accurate and comprehensive consultation history is considered one of the most important factors in ensuring a safe prescribing decision (Young et al, 2009). This can be particularly challenging when using telephone and video consultation methods where visual clues and the subtleties of language can be difficult to interpret (Car et al, 2004). Remote consultations have been a fixture in healthcare for some time but their use has been expedited in response to COVID-19 restrictions (Churchouse et al, 2021). In the out-of-hours (OOH) urgent primary care setting, the initial consultation with the patient is via a phone call and a follow-up in-person consultation only occurs when deemed clinically necessary.

This article discusses the evolution of consultation models and the adaptation of these for use in the telephone triage system used in an OOH setting. This will focus on a clinical review involving a 60-year-old gentleman, Dan (a false name for anonymity), who contacted the OOH service with concerns about potentially contracting Lyme disease following a tick bite.

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