Perceptions of Rheumatologists on Barriers and Enablers to Adoption of Interdisciplinary Models of Rheumatology Care in Ontario, Canada

Objectives Interdisciplinary models of care, where rheumatologists provide care collaboratively with interdisciplinary healthcare professionals (IHPs), have the potential to enhance the delivery of rheumatology services, yet their adoption remains limited. This study aimed to identify barriers and enablers to adopting an interdisciplinary model of care, as perceived by rheumatologists. Methods We conducted a qualitative study using semistructured interviews with rheumatologists practicing in Ontario, Canada, whose primary practice was a conventional model of care (without IHPs). Participants were purposively sampled to ensure variation in gender, career stage, practice setting, and region. The interview guide was informed by the Theoretical Domains Framework (TDF), an implementation framework used to identify determinants of health-professional behavior. We used content analysis with deductive coding to TDF domains and inductively derived within-domain themes on factors influencing adoption of interdisciplinary care. Results We interviewed 14 rheumatologists across Ontario (12 adult, 2 pediatric), of whom 9 were women (64%) and 8 were aged <40 (57%). We identified 6 TDF domains as relevant to rheumatologists’ adoption of interdisciplinary care (Table 1), with barriers and enablers varying by anticipated IHP scope/function. Participants described being optimistic they would be able to feasibly implement an interdisciplinary model with appropriate system supports (1-Optimism) and reported strong self-efficacy for training and supervising IHPs (2-Beliefs about capabilities). Participants perceived that adoption would benefit patients (improved access/equity through shorter wait times, better care coordination, improvements in health outcomes) and rheumatologists (reduced administrative workload and burnout), which they identified as key enablers (3-Beliefs about consequences). Funding was described as the primary system-level barrier. For some, limited physical space to accommodate an IHP was reported to further impede adoption. Participants perceived a shortage of suitably trained IHPs, particularly outside urban centers, as a major barrier to adoption. They anticipated that the substantial time required to train new team members, and the risk of turnover, could create non-recoverable training costs and discourage implementation (4-Environmental context and resources). Rheumatologists reported knowledge gaps regarding IHP training and scope, along with limited business and human-resources skills for recruitment and contracting, as barriers to adoption (5-Knowledge, 6-Skills). Table 1 Adoption of interdisciplinary rheumatology care: TDF domains with themes and illustrative quotes Conclusion Among rheumatologists currently practicing in a conventional care model, we identified behavioral determinants of adopting an interdisciplinary model of care. To overcome barriers and strengthen enablers, sustainable funding, workforce development (IHP training), practical implementation resources (business guidance and training), and clear blueprints of successful care models and IHP roles (set-up guidance, team compositions, workflows) are required.