ASSESSING COMMUNICATION NEEDS ABOUT TICKS AND TICK-BORNE DISEASES FOR INDIANA PUBLIC HEALTH PROVIDERS
More than 15 tick-borne diseases have been recognized in the United States (US) (Eisen (2020). Collectively, TBDs have been linked to seven different tick species in the US. Climate change, urbanization, and host migration exacerbate the threat of increasing TBD incidence and the expanding geographic distribution of ticks. Furthermore, data suggests that less than a tenth of the reportable TBDs were reported to the CDC annually. Studies from a national survey and high incidence states for Lyme disease provided evidence that healthcare providers have knowledge gaps about TBD epidemiology and diagnostics, which has yet to be examined in Indiana to our knowledge.
An anonymous survey of 597 Indiana healthcare providers was conducted between February 28th and April 10th,2020 to assess knowledge about ticks and tick-borne diseases (TBDs). The survey comprised 22 discrete and ordinal questions and one open-ended question. The study revealed that 92% of the respondents reported Doctor of Medicine (MD) (71%), Doctor of Osteopathic Medicine (DO) (8%), Physician Assistant (PA) (12%) and Registered nurse (RN) (1%) as their highest level of training and practiced in a diversity of settings including Primary care office (28%), Specialty care office (23%) and Hospital (inpatient) (20%). Analyses revealed that 39% of respondents had practiced for more than 25 years, consulted between 1-25 patients with confirmed or suspected TBD per year, and predominantly served both rural and urban communities (62% respondents). Seventy percent of respondents recognized the clinical signs and symptoms of TBDs endemic to Indiana and 96% of DOs, 94% of PAs, and 91% of MDs were aware of the limitations of the erythema migrans (EM) rash as a diagnostic criteria for Lyme disease (LD), the most common TBD in Indiana and the U.S. The majority of respondents (75%) reported using fine tip tweezers, considered best practice for the removal of an attached tick. Among respondents who used online resources to obtain information regarding diagnostic and treatment guidelines, 25-45% visited federal (CDC) and state (Indiana Department of Health, IDOH) websites.
Survey data revealed several potential knowledge gaps among Indiana state providers. Respondents reported that they were unsure about the following topics: (1) the tick species capable of disease transmission in IN (47% unsure), (2) the geographic distribution of the black legged tick, Ixodes scapularis, the vector of LD in the U.S. (56% unsure), (3) northwest Indiana as the region of the state associated with highest LD risk (49% unsure), and (4) May-July as the months considered highest risk for TBD transmission (48% unsure or answered incorrectly). These findings provided evidence to support the hypothesis under investigation in the present study that Indiana healthcare providers lack knowledge of tick vectors and TBDs risks specific to the state.Qualitative analysis was conducted for open-ended question (Q23) and resulted in coding of 597 responses into six major categories (Healthcare provider, Healthcare system, Patient Knowledge, Disagreement, Education and Not applicable) and 15 associated subcategories. Coding analyses revealed that healthcare providers are aware of their shortcomings and are receptive to online interventions. Here we present the first focused study to assess provider knowledge of ticks and TBD in Indiana. Taken together, the survey findings provide information to guide development of region-specific educational material and guidelines about ticks and TBDs for healthcare providers. We provide evidence to suggest that a continued provider education program may improve diagnosis and treatment of TBDs.