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Frequently Asked Questions for Providers

What is the Tick Collaborative Care Service (TiCC Service)?

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 TiCC Service medical lead and the specialist group occur through Virtual Care Rounds (MS 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 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.

Why has this collaborative care service been developed?

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, and
  • Provide support and educational opportunities for Primary Care Providers managing this population.

Who is eligible for the TiCC Service?

People who:

  • have a primary care provider or are registered with a Home Clinic,
  • have 3 clinical symptoms associated with tick-borne disease present for more than 3 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.

Is a positive test for Lyme disease required to access the TiCC Service?

No. Access to TiCC Service is based on eligibility (see question two) which is primarily focused on clinical symptoms.

How do you access the TiCC Service?

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 https://professionals.wrha.mb.ca/tick-collaborative-care-service/forms/ along with required investigations and blood work to the TiCC Service. Referrals can be faxed to 204-940-1686 or submitted directly via EMR.

How does the TiCC Service work?

TiCC Service provides coordinated care services between all physician groups, internal medicine, rheumatology, medical microbiology, psychology, naturopathy, pharmacy, and primary care. A detailed description of service can be found here.

What is Primary Care's role within TiCC Service?

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.

Where is the TiCC Service located?

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.

Can non-Manitobans access the TiCC Service?

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.

Will the TiCC Service conduct research?

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.

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