Reducing unplanned admissions in inflammatory bowel disease: A participatory study to inform future intervention development

Background
Unplanned and some potentially preventable hospital admissions in Inflammatory Bowel Diseases (IBD) account for nearly three-quarters of IBD inpatient stays in the United Kingdom. There is a lack of understanding of the factors that contribute to these unplanned admissions, limiting opportunities to develop meaningful interventions.

Aims
This research explored the individual, social, and systemic factors contributing to unplanned IBD admissions and co-developed a preliminary theory of change for prospective interventions.

Methods
I undertook a systems-focused, four-phase sequential exploratory mixed-methods study, using the Candidacy Framework as a theoretical lens to examine healthcare access: Studies included:
1) A scoping review of the components of IBD healthcare associated with IBD admissions.
2) A multidisciplinary clinician survey and semi-structured interviews exploring the healthcare factors and system inequalities contributing to these admissions.
3) A qualitative study with patients, clinicians and caregivers exploring the patient journey leading up to unplanned admissions.
4) A series of collaborative participatory systems mapping and co-design workshops using causal loop diagrams. Workshops co-developed prospective intervention for reducing IBD admissions.

Results
Whilst a proportion of unplanned IBD admissions were viewed as unavoidable, avoidable admissions were perceived as products of systemic barriers, impenetrable health services and delays at multiple points of access. Challenges identifying acute IBD flares, poor knowledge of services, complexity of navigating care and advocacy barriers were perceived to inhibit early intervention and access before unplanned IBD admissions, reinforcing a reliance on acute emergency services. Psychological distress was perceived as a critical reinforcing component of unplanned IBD admissions. Personalised care plans, facilitated peer support, and group education were prioritised at workshops.

Conclusion
Reducing unplanned admissions requires shifting the prioritisation and organisation of IBD care from a model of service availability to one of system permeability. Supporting confidence for people with IBD to navigate the system and self-advocate must become an explicit goal of service redesign.