An adapted health system inequity framework for avoidable inflammatory bowel disease admissions: A scoping review

Background Access to healthcare may be driving unplanned and potentially avoidable hospital admissions for people diagnosed with Inflammatory Bowel Disease (IBD). Interventions to reduce unplanned and potentially avoidable admissions need to be developed based on a clear conceptual framework that identifies the system-level access barriers contributing to these admissions. This scoping review aimed to synthesise the health system components for reducing unplanned IBD admissions to develop a conceptual framework to guide future interventions for reducing unplanned admissions.

A scoping review was conducted to identify literature exploring factors associated with unplanned IBD admissions and interventions to reduce IBD admissions. Literature published between January 2000 and October 2024 was identified from four electronic databases (Medline, Embase, CINAHL and Pubmed). A narrative synthesis presented the findings, guided by Candidacy Framework, to understand issues in healthcare access.

and conclusions Of 1980 records identified, 17 were included. Avoidable IBD admissions result from inequity across the patient journey through healthcare specifically in access to: (1) earlier intervention during a flare, (2) specialist clinical advice about symptoms and psychosocial issues, (3) rapid access to outpatient care, (4) patient education, (5) systems that support self-management, (6) proactive care strategies, and (7) collaborative health professional working and referrals. Addressing service permeability (ease of using services) and local production of candidacy (patient-provider relationships and macro-structural conditions) are understood as most important for addressing avoidable unplanned IBD admissions. The Health System Access Framework is useful for understanding how services need to address patient care. Lay summary Many unplanned hospital admissions for inflammatory bowel disease may be avoided. This review found that quicker access to specialist advice, proactive care, and patient education is crucial. This study developed a framework to help healthcare providers improve services and reduce these admissions for patients. Competing Interest Statement AJL has acted as a speaker or consultant for Takeda, BMS, Sandoz, JNJ, Celltrion and Medtronic. Funding Statement Funding from The University of Sheffield PhD Research Scholarships is acknowledged in supporting RLH to conduct this review. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Financial disclosures: Funding from The University of Sheffield PhD Research Scholarships is acknowledged in supporting RLH to conduct this review. Conflicts of interest: AJL has acted as a speaker or consultant for Takeda, BMS, Sandoz, JNJ, Celltrion and Medtronic. Data availability: Data available in supplementary material Term "inequity" has been updated to "access" in title of the framework. Further clarification on difference between this scoping rev iew and a health inequalities review we conducted in IBD care added. Data Availability All data produced in the present work are contained in the manuscript