OP183 Interventions to reduce avoidable hospital admissions among socio-economically disadvantaged groups in high-income countries: a systematic review

Background

Health systems are experiencing increasing compound pressures. Raising demand, underpinned by the ageing population and the rise in cost of living exacerbates these pressures further. We know that avoidable hospital admissions are a big healthcare costs. Across high-income countries we see increase numbers in avoidable admissions. Socio-economically disadvantage groups are at increased risk of avoidable hospital admissions. Initiatives are neded to reduce the number of avoidable hospital admissions.

Methods

This systematic review evaluates interventions aimed at socio-economically disadvantaged populations to reduce hospital admissions and identify any knowledge gaps. We searched MEDLINE, Embase, CINAHL, Cochrane CENTRAL and the Web of Knowledge platform for studies published between Jan 1 2000 and Feb 23 2022 (PROSPERO CRD42019153666). We incldued quantitative studies of socio-economically disadvantaged populations, conducted in an member country of the Organisation for Economic Co-operation and Development, with universal health care and reporting hospital admission or readmissions were included. We assessed study quality using the Effective Public Health Practice Project (EPHPP) tool. We summarised studies using a narrative synthesis approach.

Results

28655 records were identified from the initial database search and 128 through additional methods. Titles and abstracts of 23496 studies were screened and 541 full texts were reviewed. 17 studies were included in the final review from thirteen countries. We present interventions across three domains of action – population health and cross sectoral policy, health and care system or integrative interventions. We found that interventions targeting socio-economically disadvantaged groups can reduce avoidable hospital admissions. Integrative approaches, especially those focused on empowerment of patients were effective in reducing avoidable admissions. No studies presented co-produced interventions, and across the literature pre-existing health inequalties were poorly described.

Conclusion

We found that integrative interventions, working across domains of action, were effective at reducing admission of socio-economically disadvantaged groups. Engagement with target groups to identify their health needs that lead to avoidable hospitalisation may be key in this work and should be reported and disseminated widely. Future health research should explore the absolute as well as the relative impact of health interventions describing the baseline characteritics and any differential impacts across the social gradient.