P0107 Conceptualising avoidable inflammatory bowel disease admissions from the perspective of clinicians: An international mixed methods study

Background

Inequalities exist in inflammatory bowel disease (IBD) healthcare access, experience and outcomes including in unplanned IBD admissions1. Differing terms are used for unplanned admissions including avoidable, preventable, unnecessary and unwarranted - used interchangeably and without clear definition 2. This study explored the causes, consequences and barriers to mitigating IBD admissions from clinicians’ perspective.

Methods

A mixed methods study recruited IBD clinicians (gastroenterologists, specialist IBD nurses, surgeons and other allied health professionals) in two inter-related work packages. 1) an international survey developed with IBD clinicians implemented following initial pilot 2) semi-structured qualitative interviews. Clinicians ranked the frequency of types of unplanned admission and contributing factors allocating weighting to a total of 100. Survey results were analysed using descriptive statistics and Friedman and Wilcoxon signed ranked tests. Qualitative interviews were analysed by inductive thematic analysis.

Results

145 clinicians started the survey. 66 (45.5%) completed all questions. 80 (55.2%) distinguished between terms, 69 (47.6%) also ranked all admissions. 13 clinicians took part in interviews (11 UK). Preventable admissions were ranked as occurring most often (57.5% ranked first, mean rank 1.62/4) (p <0.001) (Table 1). However, 57 (70%) felt that avoidable and preventable IBD admissions were the same concept. For all unplanned IBD admissions, ranking of reasons were significantly different for all factors (p <0.001) (Table 2). Clinicians ranked unpreventable progression of the disease as most important (mean rank 32.20/100) (p <0.05) followed by missed opportunities for earlier intervention in outpatient care (mean rank 22.39/100) and patient access issues (mean rank 19.52/100). Qualitative findings echoed patient access issues which included lack of timely access to advanced therapies and outpatient care. Health literacy barriers including lack knowledge of how to access services was also identified. Clinicians highlighted under-resourced services and sub-optimal service organisation as prominent issues

Conclusion

Despite the lack of clarity in existing literature, clinicians mostly feel that avoidable and preventable IBD admissions are the same concept, and consistent terminology should be defined. Whilst clinicians emphasised that unplanned admissions may be necessary, avoidable admissions were also viewed as an important issue. Reasons for unplanned admissions are diverse. IBD services need to consider all of these in order to tackle IBD admissions.

References

1-Hawkins RL, Zia M, Hind D, Lobo AJ. Inequalities in Healthcare Access, Experience and Outcomes in Adults With Inflammatory Bowel Disease: A Scoping Review. Inflamm Bowel Dis. Published online April 11, 2024:izae077. doi:10.1093/ibd/izae077

2-Booker M, Purdy S. Towards new definitions of avoidable hospital admissions. Br J Gen Pract. 2022;72(723):464. doi:10.3399/bjgp22X720725