Introduction
Lyme disease was first identified in 1975 as the cause of an epidemic of arthritis occuring near Old Lyme, Connecticut. First thought to be a geographic and seasonal cluster of "juvenile rheumatoid arthritis," Lyme disease was later found to be associated with or preceded by a rash, known as erythema chronicum migrans, and other clinical findings. Lyme disease is now known to be a complex multi-system disease that results from the immunologic response to infection with the tick-borne spirochete Borrelia burgdorferi.
Lyme disease is the most common vector-borne disease in the United States, with nearly 100,000 cases reported between 1982 and 1996. Because Lyme disease can have protean clinical manifestations, clinical diagnosis is more challenging and creates a reliance on serologic testing. Serologic testing cannot substitute for clinical judgement, however, and misdiagnosis of Lyme disease can be a problem. Practice guidelines offer a framework for physician decision making but alone have met with little success in changing physician practice. To help bridge the gap between guidelines and practice, the American College of Physicians, under a cooperative agreement with the Centers for Disease Control and Prevention (CDC), created the ACP Initiative on Lyme Disease. The specific aims of this three-year project were to:
- Improve early recognition and secondary prevention of Lyme disease by physicians
- Reduce inappropriate diagnostic testing and treatment of suspected Lyme disease
- Convey more clearly when to refer Lyme disease patients for subspecialist care
- Increase physician reporting of Lyme disease cases for CDC surveillance efforts
- Encourage local consenus development on Lyme disease evaluation consistent with the framework of national practice guidelines and endemic disease projects
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