An adapted health system access framework for avoidable inflammatory bowel disease admissions: a scoping review.

Inflammatory bowel diseases (IBD) are complex and relapsing conditions of the gastrointestinal tract. Many people living with IBD (PLwIBD) endure repeated hospital encounters. In the UK, 1 in 7 PLwIBD are diagnosed during emergency hospitalization with rising rates of unplanned hospitalization for PLwIBD. Unplanned IBD admissions have profound social and psychological impact and should be considered a healthcare priority. Unplanned IBD admissions account for high healthcare costs that are comparable to major diseases such as cancer and heart disease. Understanding how some admissions for IBD may be avoided is therefore important. The definitions of avoidable and preventable admissions in chronic conditions are varied and poorly defined which is problematic when attempting to address avoidable IBD admissions. Improper definitions of concepts are a common issue in healthcare research whereby healthcare concepts often have similar and overlapping meaning. For example, inconsistencies in definitions of “emergency” and “urgent” abdominal surgery for IBD have been previously highlighted. It is unclear if there are distinct differences in how terms such as “avoidable” or “preventable” IBD admissions are being used. Clarifying terms and the components of avoidable admissions in IBD through a conceptual framework could support future intervention development, healthcare providers decision making, more effective distribution resources, and importantly, more clearly, and defined future research tackling this issue. Patient access to healthcare is a common theme across all avoidable admissions and a prominent issue for PLwIBD. The Candidacy Framework (CF) is an established framework for understanding inequalities in healthcare access and in the emergency care setting. Across 7 interrelated constructs (outlined in ), the CF describes the patient journey through healthcare and eligibility for care, incorporating individual, interpersonal, organizational and structural contexts of care access. Candidacy has been applied in understanding access to cancer services, emergency care and more recently in rheumatoid arthritis care. Candidacy describes how a person must first recognize a health need (identification), know how and where to seek help (navigation), gain entry to services (permeability), present their case to a clinician (appearance), and receive a professional judgment about eligibility for care (adjudication). Patients may then accept or resist what is offered, and all of these stages are shaped by local operating conditions such as workforce capacity, service policies, and existing patient-provider relationships. It is the cumulative effect of barriers across these stages, rather than any single factor, that the CF captures.