An adapted health system access 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 synthesize the health system components for reducing unplanned IBD admissions to develop a conceptual framework to guide future interventions for reducing unplanned admissions.

Methods

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 4 electronic databases (Medline, Embase, CINAHL, and PubMed). A narrative synthesis presented the findings, guided by Candidacy Framework, to understand issues in healthcare access.

Results 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.