Primary Care Provider Perspectives on Lyme Disease Risk, Prevention and Vaccination: A Mixed-Methods Study in U.S. High-Incidence States
L Hannah Gould, Stephanie Duench, James H Stark, Niyati Patel, Matt Killingsworth, Jason RiisAbstract
Background and aims
As Lyme disease (LD) vaccine candidates progress toward approval, understanding healthcare provider (provider) practices and perspectives on LD prevention is critical for successful implementation.
Methods
Building on existing research, this study used a sequential mixed-methods design comprising a quantitative survey of 586 providers and 15 qualitative interviews in high-incidence areas to identify two key descriptive gaps.
Results
First, providers discussed prevention with fewer patients than they deemed at meaningful risk (risk-prevention gap): providers self-reported discussing prevention in 33% of annual wellness visits despite perceiving 52% of their patients as being at meaningful risk of a tick bite that could lead to LD (p < .001). Second, providers estimated they would recommend a hypothetical LD vaccine to significantly more patients (68% on average) than currently receive prevention counselling (prevention-vaccination gap, p < .001). Qualitative interviews suggested that providers perceived time constraints and competing clinical priorities as contributing to the risk-prevention gap, and that the prevention-vaccination gap was related to providers' perception that vaccination discussions are more time-efficient than behavioural counselling. Multivariable regression additionally identified paediatric specialty and greater time allocated per wellness visit as independent predictors of more frequent prevention counselling, while paediatric specialty also predicted higher anticipated vaccine recommendation.
Conclusions
Together, these findings suggest that while providers demonstrate strong interest in LD vaccination, barriers create gaps between risk perception, prevention counselling, and the proportion of patients who would be recommended a hypothetical vaccine to protect against LD. Successful vaccine implementation will depend on strategies that help providers navigate these barriers within time-constrained clinical encounters.