Does Paging Clinicians about Tick-Borne Disease Serological Results Impact Clinical Care? A Retrospective Analysis of 70 Cases in North Carolina

Neha V. Mokashi Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;

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Amanda Brown Marusiak Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;

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Dana Giandomenico Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;

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Meghan Cleinmark McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, North Carolina;

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John L. Schmitz McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, North Carolina;
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina;

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Ross M. Boyce Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;
Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;
Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina

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ABSTRACT.

Delayed treatment of Rocky Mountain spotted fever is associated with increased morbidity and mortality. Because the diagnosis cannot be established from a single serological test, guidelines recommend empirical antibiotic initiation in suspect patients. We evaluated a policy used by UNC Health of paging clinicians when acute testing for Rickettsia returned with a titer ≥1:256. Our objective was to assess the potential effect of paging on routine treatment practices. Notably, we found that a high proportion of cases (N = 28, 40%) were not prescribed antibiotics until the results were available. The vast majority of these cases did not have evidence of compatible symptoms or disease progression. These findings suggest that paging may have prompted unnecessary treatment. Overall, the policy, which has now been discontinued, appears to have had limited benefit. Efforts are urgently needed to improve adherence to testing and treatment guidelines.

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Author Notes

Financial support: This work was supported by a Creativity Hub Award to R. M. Boyce from the UNC Office of the Vice Chancellor for Research. R. M. Boyce is also supported by a Caregivers at Carolina Award made by the Doris Duke Charitable Foundation (Award 2015213). Research was supported by the North Carolina Translational and Clinical Sciences Institute, which is supported by the National Center for Advancing Translational Sciences and National Institutes of Health through grant award number UL1TR002489.

Disclosures: All authors have completed the International Committee of Medical Journal Editors uniform disclosure form and declare no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years except that noted in the funding section; no other relationships or activities that could appear to have influenced the submitted work. Study procedures were approved by the UNC Institutional Review Board (IRB 21-1519). Individual informed consent was not required for the analysis, given that the research involved existing, routinely collected health information.

Authors’ addresses: Neha V. Mokashi, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, E-mail: nehavm@live.unc.edu. Amanda Brown Marusiak, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, E-mail: akbm@unc.edu. Dana Giandomenico, Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, E-mail: danag@med.unc.edu. Meghan Cleinmark, McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, NC, E-mail: Meghan.Cleinmark@unchealth.unc.edu. John L. Schmitz, McLendon Clinical Laboratories, University of North Carolina, Chapel Hill, NC, and Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, E-mail: john.schmitz@unchealth.unc.edu. Ross M. Boyce, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, and Carolina Population Center, University of North Carolina, Chapel Hill, NC, E-mail: roboyce@med.unc.edu.

Address correspondence to Ross M. Boyce, Division of Infectious Diseases, University of North Carolina, 123 West Franklin St., Ste. 230, RM 2151, Chapel Hill, NC 27516. E-mail: roboyce@med.unc.edu
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