title: Magnitude and causes of loss to follow-up among patients with viral hepatitis at a tertiary care hospital in Saudi Arabia.
abstract: BACKGROUND
  Non-adherence with recommended follow-up visits is a major barrier for completing treatment of viral hepatitis and is consequently associated with unfavorable outcomes of health services.
  
  
  OBJECTIVE
  To estimate the magnitude and identify perceived reasons and patient characteristics associated with loss to follow-up in a tertiary care setting.
  
  
  METHODS
  A two-step cross-sectional study design was used, including a chart review (2011) followed by phone survey (2012). Loss to follow-up was recorded among those who were diagnosed with hepatitis B (HBV) or C (HCV) during 2009-2010 but never returned for recommended/scheduled follow-up appointment(s).
  
  
  RESULTS
  A total of 328 patients (202 HBV and 126 HCV) were included in the current analysis. The average age was 49.6±17.9years, and 57% were males. Out of 328, 131 (40%) were not advised to do follow-up, and 98 (30%) were not doing follow-up. Perceived reasons for loss to follow-up were as follows: unaware that a follow-up appointment was scheduled (69%), never informed of need for follow-up by healthcare provider (15%), personal belief that follow-up was not necessary (9%), logistical reasons (3%) and other reasons (5%). Loss to follow-up was higher among those who had been diagnosed with HBV, referred by non-liver-related specialty, never advised to follow-up, unaware of their diagnosis, incorrectly identified their type of hepatitis, lacking hepatitis complications, having full medical coverage, pregnant, and those with low knowledge or negative attitude towards hepatitis.
  
  
  CONCLUSIONS
  Loss to follow-up is a significant problem among patients with hepatitis in a tertiary care center, with several patient and system failures being implicated.
authors.affiliation: Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Gulf Cooperation Council (GCC) States and WHO Collaborating Center for Infection Prevention & Control, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: balkhyh@ngha.med.sa.
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Balkhy
authors.affiliation: Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Gulf Cooperation Council (GCC) States and WHO Collaborating Center for Infection Prevention & Control, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Egypt.
authors.forename: Aiman
authors.initials: A
authors.lastname: El-Saed
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Hepatology Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Sanai
authors.affiliation: Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alqahtani
authors.affiliation: Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Mashael
authors.initials: M
authors.lastname: Alonaizi
authors.affiliation: Community Medicine Department, Faculty of Medicine, Mansoura University, Egypt.
authors.forename: Nermeen
authors.initials: N
authors.lastname: Niazy
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Hepatology Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Aljumah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000628:therapy*; D006526:Hepatitis C / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012529:Saudi Arabia; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Loss to follow-up; Management; Saudi Arabia; Tertiary care; Viral hepatitis