Exploring healthcare experiences and access needs in unplanned hospital admissions for Inflammatory Bowel Disease: A multi-perspective qualitative study
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Background
Unplanned hospital admissions in Inflammatory Bowel Diseases (IBD) account for nearly three-quarters of IBD inpatient stays in the United Kingdom. Although costly to services and distressing for patients, research exploring experiences and potential drivers of admissions is limited. We undertook a qualitative study to explore the healthcare experiences and access needs of people with IBD who had unplanned admissions, along with their caregivers and clinicians.
Methods
Semi-structured interviews with 25 participants from a single tertiary IBD service in England ( 17 people with IBD, 3 informal caregivers, 5 clinicians) were conducted. We applied thematic framework analysis, guided by the Candidacy Framework, and worked with 2 patient and public contributors to generate final themes.
Results
We identified four themes: ‘Difficulties in Identifying flares and asserting severity before admission’ , summarised the prevailing uncertainty in identifying a flare and access to timely IBD care. ‘Navigating a disjointed healthcare system’ , highlighted how lack of care plans and systemic barriers can delay access. ‘Emergency care access challenges’ highlighted the gaps in emergency and inpatient care during flares. Whilst ‘fighting for care and individual advocacy needs’ , described the persistent assertion for care that may disproportionally impact access to vulnerable groups, also highlighting the importance of positive interpersonal relationships.
Conclusions
Individual, interpersonal and healthcare factors across the patient pathway were perceived to shape access to care in unplanned IBD admissions. Potentially reducing admissions requires proactive strategies, including the integration of patient education, monitoring tools, establishment of specialist rapid-access pathways, and formal psychological support to address barriers to access.
Summary
Research exploring experiences of IBD admissions is limited. We conducted qualitative interviews to explore patient, caregiver and clinician perspectives revealing individual, interpersonal and healthcare factors that shaped access and experiences of care before and after admissions.
What is already known?
Unplanned IBD admissions are frequent, costly, and distressing for patients. Whilst recognised as markers of suboptimal service quality, research into the healthcare experiences and systemic drivers behind these admissions remains limited.
What is new here?
This is the first study to explore healthcare access leading up to unplanned IBD admissions from multiple perspectives. We show that poor knowledge of flares and services, patient and clinicians’ uncertainty during initial contact, and the overall impermeability of healthcare can delay access and contribute to unplanned IBD admissions. Furthermore, persistent assertion for care is required in IBD that may disproportionally impact access for vulnerable groups.
How can this study help patient care?
Findings from this study can directly inform health service interventions to reduce IBD admissions including improved patient flare and navigation information, patient monitoring tools and establishing specialist rapid-access clinics to provide alternatives to A&E. Furthermore, embedding formal psychological support can address the emotional barriers to accessing care.
