Tick Collaborative Care Service TiCCS
Given the increasing burden and challenges associated with diagnosing and managing cases of possible late Lyme and/or other emerging tick borne diseases, a provincial Tick Collaborative Care (TiCC) Service has been developed.
The TiCC Service is a group of health-care specialists working together to diagnose and treat tick-borne disease in Manitoba. The service helps patients by connecting their primary care provider to appropriate health professionals, including specialists (internal medicine, rheumatology, medical microbiology, psychology, naturopathy, and pharmacy), who will be involved in a collaborative approach to their care.
Preventative Treatment after a High-Risk Tick Bite
With the number of Lyme disease cases increasing in southern Manitoba, health-care providers should consider preventative treatment with antibiotics (see Quick Reference Guide for Health Care Providers for more information) for patients with a high risk tick-bite. This preventative treatment should be considered when the following four criteria are met:
- The tick can be reliably identified as a blacklegged tick (Ixodes scapularis), and
- The tick was attached for a minimum of 36 hours, or engorged, and
- The tick was picked up from a location in southern Manitoba (south of the 53rd parallel), or another known risk area outside of Manitoba for Lyme disease (map of Lyme disease risk areas in Canada can be found here), and
- There are no known allergies to the antibiotic, doxycycline.
Individuals should continue to monitor themselves for symptoms in the months following their tick bite, even if they receive preventative treatment.
More information is available here.
Frequently Asked Questions
TiCC Service coordinates care for patients through introduction of a centralised process, led by internal medicine physician Dr. Stephen Goulet, who has special interest in tick-borne illnesses. There is also a specialist group affiliated with TiCC Service, which has representation from rheumatology, medical microbiology, psychology, naturopathy, and pharmacy. Interactions between the TiCC Service medical lead and the specialist group occur through Virtual Care Rounds (Microsoft Teams).
Once patients are assessed by Dr. Goulet, he may refer the case to Virtual Care Rounds, in which case the primary care provider would be notified and invited to attend. These Virtual Care Rounds provide a unique collaborative approach to patient care. Through participation in virtual rounds, primary care providers can review cases with specialists, obtaining support and information regarding the patient care plan. After the virtual rounds, attendees will receive a case summary, which will include any plans for additional diagnostics or referrals and will highlight the coordinated plan of care. The service works closely with primary care, enhancing the ability to manage tick-borne illness in the community.
The burden of tick-borne diseases, most notably Anaplasmosis and Lyme disease, continues to increase in both Canada and Manitoba. While early treatment is typically successful, challenges arise when dealing with possible late Lyme disease and/ or emerging tick-borne diseases. Symptoms of late Lyme disease are often indistinguishable from many other chronic diseases, making diagnosis and treatment difficult. In addition, co-infection with tick-borne diseases can result in more severe, prolonged or typical symptoms.
Faced with this increasing burden, the Tick Collaborative Care Service (TiCC Service) was developed to achieve three objectives:
- Streamline, coordinate and improve client-centred care for patients presenting with possible late Lyme disease and/or other emerging tick-borne diseases
- Enhance collaboration between primary care and specialists
- Provide support and educational opportunities for primary care providers managing this population.
- Have a primary care provider or are registered with a Home Clinic,
- Have three clinical symptoms associated with tick-borne disease present for more than three months,
- Are 17 years of age or greater*
*For patients under 17 years of age, TiCC Service will provide contact information for a pediatrician with special interest in tick-borne diseases.
No. Access to TiCC Service is based on eligibility (see question two) which is primarily focused on clinical symptoms.
Referrals are made through primary care providers. If tick-borne disease is suspected and the patient meets eligibility criteria, primary care can submit a completed referral form along with required investigations and blood work to the TiCC Service. Referrals can be faxed to 204-940-1686 or submitted directly via EMR.
Referrals to TiCC Service are consult based. TiCC Service improves access to and coordinates specialists’ advice but does not take over patient care. Once TiCC Service has developed a client care plan, primary care will receive a copy and will continue to manage their patients’ ongoing care. TiCC Service is accessible for additional support, as needed.
The TiCC Service is not a bricks and mortar clinic. While the primary care nurse and assistant will have office space, appointments with them will be conducted by phone. Appointments with the TiCC Service medical lead will be held virtually and/or onsite at his Winnipeg office location. Virtual vs in person appointments with the medical lead will be determined on a case-by-case basis. Should follow up appointments with medical specialists and/or allied health professionals be advised, they will advise whether it will be held in their respective clinics or conducted virtually.
No, the TiCC Service is a service for Manitoba residents only. Out-of-province residents should consult their respective health authorities for information about health-care services.
Research proposals will be considered if aimed at improving the overall care and management of patients presenting with possible late Lyme disease and/ or other emerging diseases. Any research associated with the TiCC Service will follow the appropriate ethical procedures and approvals.