CLINICIANS

At TXLDA, one of our most important goals is to further professional education on Lyme disease and its co-infections. These diseases are poorly understood by most physicians and educational opportunities to learn evidence-based, patient-centered approaches to the treatment of them are limited. TXLDA is the only organization in Texas providing accredited CME on the diagnosis and treatment of tick-borne diseases.

Online CME Course Modules pertaining to Tick-Borne Diseases

The links below will take you to online CME courses for clinicians that are accredited by the American Academy of Family Physicians. (Approved for up to 1.5 prescribed credits by the AAFP. Physicians should claim only the credit commensurate with the extent of their participation in the activity.)

(Additional program modules forthcoming.)

Online CME Courses

Facts for Physicians: Fact sheet for physicians published on December 8, 2015.

Texas Legislation – Regarding Clinician CME Requirements

In 2011, the Texas Legislature enacted HB2975/SB1360, an act relating to continuing education for physicians and nurses regarding the treatment of tick-borne diseases. Following patient and other testimony, which showed that tick-borne diseases are prevalent in Texas, that Texas patients find it extremely difficult to get diagnosed and treated for these diseases, and that patients often must seek medical help outside Texas, the Legislature reached compromise legislation between patient advocacy groups and the Texas Medical Association.

HB2975/SB1360 encourages physicians in Texas whose practice includes the treatment of tick-borne diseases to seek continuing education in this subject. It calls on the Texas Medical Board to adopt rules to establish the content of these courses and mandates that the board seek input from affected parties and review relevant courses, including courses that have been approved in other states. It mandates that these courses must represent an appropriate spectrum of relevant medical clinical treatment for tick-borne diseases.

The law also says that if relevant, the TMB shall consider a physician’s participation in such courses if the physician is being investigated for his/her selection of clinical care for treatment of these diseases and the physician completed the courses no more than two years before the start of the investigation.

In accordance with the law, the Texas Medical Board made changes to its Rules, as follows: Rule 166.2 Continuing Medical Education (6)(A) A physician whose practice includes the treatment of tick-borne diseases should complete CME in the treatment of tick-borne diseases that meet the requirements described in paragraph (1)(A) – (E) of this subsection.

The requirements for these courses must meet one of the following conditions:

(A) designated for AMA/PRA Category 1 credit by a CME sponsor accredited by the Accreditation Council for Continuing Medical Education or a state medical society recognized by the Committee for Review and Recognition of the Accreditation Council for Continuing Medical Education;
(B) approved for prescribed credit by the American Academy of Family Physicians;
(C) designated for AOA Category 1-A credit required for osteopathic physicians by an accredited CME sponsor approved by the American Osteopathic Association;
(D) approved by the Texas Medical Association based on standards established by the AMA for its Physician’s Recognition Award; or
(E) approved by the board for medical ethics and/or professional responsibility courses only.

TXLDA has made it part of its mission to bring qualified CME courses on tick-borne diseases to Texas. An online CME course is currently being developed and additional live courses may be scheduled in the future. This information will be posted on the TXLDA website when appropriate.

Education Grants For Physicians/Nurse Practitioners

TXLDA strongly recommends clinicians with an interest in treating Lyme and other tick-borne diseases to obtain further CME offered in conjunction with conferences of the International Lyme and Associated Diseases Society (ILADS). ILADS organizes conferences throughout the year at various locations both domestically and overseas. You can read about them here.

TXLDA provides a limited number of grants to Texas physicians to enable them to attend the ILADS conference to obtain CME. If you would like to apply for a grant for this purpose, please contact us and tell us about your interest. We will ask you to submit a brief proposal including your interest in Lyme disease and your intention to use the CME to benefit Texas patients with tick-borne diseases.

ILADS offers educational grants to its members through its non-profit Educational Fund (ILADEF). Physicians receive hands-on experience in up to two weeks participation in the practice of an ILADS physician with experience in treating thousands of Lyme disease patients. Visit this link to read about this program. If sufficient ILADS funds are not available for a Texas applicant, TXLDA will do its best to sponsor.

Treatment

Diagnosis of a tick-borne illness can be difficult but must be considered within the differential diagnosis in Texas. The confusion over the gold standard Bulls Eye rash can be eliminated by simply referring to the Lyme Disease Research Foundation poster (affiliated with Johns Hopkins and shared by Lymemd.org) Targeting Lyme Rashes Poster. Additionally, several studies indicate that an EM rash, of any sort does not present in a large portion of CDC+ Lyme patients. (See references on Publication page.)

The various considerations pertaining to the CDC 2 tier testing and the sensitivity/specificity of the currently available FDA approved serological tests is discussed in detail in 2014 Guidelines described below. There are many differing opinions amongst physicians who treat Lyme/tick-borne disease patients on a daily basis. Some prefer to initially support the immune system and the patients general health prior to starting treatment of the infectious process. Some prefer to diagnose/treat co-infections first, some treat the Borrelia first, and some believe that attacking all infections simultaneously is best. The individual preferences of each physician are similar to those found in any other specialty.

The consistent ideology is that a single agent will not eradicate the infection. It has been shown that the Borrelia bacteria can be found in different forms which will require different types of antibiotic agents. Combinations of various therapeutic agents in a cocktail approach is proven to be effective based on patient efficacy reports. Since the diagnosis of exactly which type of infections and which strains are present is difficult due to the lack of quality testing, the clinician must often rely on previous patient experience or the experience of colleagues who have treated tick-borne disease for many, many years. For this reason, TXLDA offers and encourages clinicians to take advantage of training opportunities with other more experienced physicians.

What Every Physician Should Know About Lyme Disease

Please refer to the brochure below which will provide clinical guidance considerations, along with peer-reviewed published studies that will help a clinician in making clinical judgments and decisions. What Every Primary Care Physician Should Know about the Diagnosis of Lyme Disease by Elizabeth Maloney, MD

New 2014 ILADS Treatment Guidelines

The 2014 Guidelines on the Diagnosis and Treatment of Lyme Disease can be read here and are the most up to date evidenced-based guidelines available. These guidelines are also found on the National Guidelines Clearinghouse (NGC) website. (Part of the Agency for Healthcare Research and Quality (AHRQ)-US Department of Health and Human Services.) These new guidelines are the ONLY tick borne disease guidelines utilizing the Institute of Medicine (IOM) standards based on GRADE analyses.