Guideline for lost-to-follow-up Type-1 diabetes patients at public hospitals in Ethiopia

Abstract

Introduction: Lost-to-follow-up (LTFU) among Type-1 diabetes patients presents a significant challenge in diabetes care, leading to poor health outcomes and increased disease complications.

Aim: The study aims to explore the experiences of patients and healthcare workers to understand lost to follow-up among patients with Type 1 diabetes, and develop guidelines to address LTFU.

Method: The study was conducted in four phases, with Phases 1 and 2 focusing on data collection, analysis, and presentation of empirical findings, and Phases 3 and 4 were dedicated to guideline development and validation. Using a qualitative phenomenological design, data for the empirical study were collected from patients and healthcare workers through semi-structured interviews guided by the Health Belief Model. The guideline was developed based on evidence generated from empirical findings, a literature review, and expert input from focused discussions. Finally, the guideline was validated by a panel of experts through a structured consensus development meeting.

Result: The findings reveal the real-world experiences of healthcare workers and patients, leading to the development of comprehensive guidelines to reduce lost-to-follow-up among Type 1 diabetes patients. The study developed and validated comprehensive guidelines covering eight key areas: patient education, financial support, tracing of patients lost to follow-up, quality of care, reduction of waiting times, establishment of robust cohort follow-up systems, reinforcement of patient support mechanisms, and monitoring and evaluation.

Conclusions: The study identified interconnected patient and healthcare workers’ related challenges and developed validated, context-specific guidelines to improve T1D patient retention. The guidelines are designed to inform policymakers, healthcare institutions, and practitioners in enhancing patient retention and strengthening follow-up services for Type 1 diabetes patients in the public hospitals in Ethiopia.