Navigating the gap: the challenge of applying treat-to-target in routine lupus care-a national perspective.

OBJECTIVE: (1) To explore practice patterns and variability in the management of systemic lupus erythematosus (SLE) in Spain, including the adoption of the treat-to-target (T2T) strategy; (2) to identify key multilevel contextual factors, barriers and facilitators; and (3) to propose strategies to overcome the identified barriers. METHODS: A qualitative analysis was conducted using a contextual analysis (CA) framework based on the components of the Basel Approach for coNtextual ANAlysis. This involved collecting contextual data through a literature review and other relevant sources, as well as collecting primary data to address gaps via structured focus groups with rheumatologists. RESULTS: Considerable variability in SLE management was described by rheumatologists across regions and healthcare centres. Major barriers included disease complexity, delayed diagnosis, workforce shortages, limited training and awareness among healthcare professionals, insufficient multidisciplinary collaboration, underutilisation and lack of standardisation of clinical indices, inadequate patient education and poor integration of patient-reported outcomes into electronic medical records. Implementing T2T and clinical guidelines was rare due to perceived complexity, time constraints, a lack of digital support and limited training. Rheumatologists proposed several strategies, including improved training, structured referral pathways, digital solutions, shared decision-making tools, practical checklists and the development of multidisciplinary care networks. CONCLUSIONS: This CA highlights significant challenges in implementing evidence-based SLE management in Spain, particularly regarding the adoption of the T2T strategy. Addressing contextual factors at the healthcare provider, organisational and patient levels is crucial for improving the quality of care and patient outcomes. These findings lay the groundwork for designing tailored national-level implementation initiatives.