Patient-initiated Follow-up in Diabetes care: a systematic review

This protocol contains materials related to a systematic review assessing the effectiveness of patient-initiated follow-up (PIFU) models in the management of diabetes. PIFU is an alternative care delivery approach in which patients initiate contact with healthcare services based on need, rather than attending pre-scheduled, provider-led follow-up appointments. This model has been proposed as a strategy to improve efficiency, patient autonomy, and responsiveness of care, particularly in the context of chronic conditions. The review aims to evaluate the impact of PIFU on clinical outcomes (e.g., glycaemic control), healthcare utilization, patient-reported outcomes (e.g., quality of life, satisfaction), and safety. It also explores the implications of PIFU for health system performance, including resource use and service organization. The review includes randomized controlled studies comparing PIFU with usual care (scheduled follow-up). Where appropriate, meta-analysis will be conducted, and heterogeneity will be assessed. Subgroup will be analysed to explore variations by patient characteristics, intervention design, and healthcare setting. The review also considers issues related to equity, including differential access and outcomes across population groups. This work contributes to the evidence base on alternative follow-up models in chronic disease management and informs ongoing efforts to redesign care pathways toward more flexible, patient-centred, and sustainable systems.