'Lost to follow-up': Reasons for discontinued surveillance in a follow-up register

Abstract

Many doctors, in both hospital and primary care, experience difficulties in the follow-up of patients who require long term surveillance. An evaluation has been made of the performance of a register in maintaining lifelong follow-up in patients treated for thyroid disease. In 5454 patients treated in four teaching hospitals in Scotland, the estimated 8-year cumulative incidence of discontinued follow-up ranges from 5.4±0.7 (s.e.) per cent to 8.4±1.1 (s.e.) per cent. Records reveal four main reasons for failure to maintain follow-up with the register: patient movement, patient unwillingness to accept follow-up arrangements, general practitioner withdrawal of patients from the register and retention of patients at specialist clinics. The study indicates weaknesses in the usual methods of communicating with patients and doctors, even under near 'optimum' conditions of follow-up. The model provided by the register could now be used to test the effects of modifications to the follow-up procedures withthe aim of improving the efficiency of long term surveillance.