Inequities in inflammatory bowel disease care: a Tasmanian case study with proposed solutions

There is well-recognised inequity of care for people treated with inflammatory bowel disease (IBD) between metropolitan and regional areas. We aim to describe these barriers to care using Tasmania as a case example and to suggest solutions for addressing these barriers that can be used in Tasmania and beyond. Tasmania has some of the highest rates of IBD in the world, with high rates of advanced therapy use reflecting a more complex population. The landscape of IBD care in Tasmania is marked by diverse challenges, some of which are unique to the state and others shared across regional Australia, all of which we appreciate negatively affects IBD outcomes in Tasmania. We formed a multidisciplinary working group from all three health services in Tasmania and identified keys issues facing Tasmanian's with IBD. The issues identified and proposed solutions were guided by Australian IBD reports and care standards, major society guidelines and our experience within the health service. The key barriers we describe include the underserviced IBD workforce, lack of multidisciplinary care, the isolation of the North West, inadequate expertise in certain areas and the absence of research and administrative infrastructure. We have developed a set of solutions designed to provide an actionable framework for improving care for Tasmanians living with IBD. These solutions encompass the development of multidisciplinary care in a regional setting, enhancing the IBD workforce, developing support for remote areas, upgrading diagnostic output, creating statewide research databases and investing in local training pathways. This action plan may serve as a model for other regional settings to deliver more equitable care in Australia and beyond.