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

Abstract

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 of 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.