Building Consensus on Key Strategies for the Implementation of Interdisciplinary Team-Based Rheumatology Care in Canada

Objectives While interdisciplinary team-based models of rheumatology care have the potential to transform rheumatology service delivery, there is no collective understanding on how best to implement them. This study aimed to identify and prioritize implementation strategies for optimal team-based models of rheumatology care based on the consensus of Canadian rheumatology health professionals.

Methods We conducted a modified Delphi study with Canadian rheumatologists and interdisciplinary health professionals (IHPs) with experience working in interdisciplinary rheumatology care teams. We developed an initial list of implementation strategies from a case study evaluation,[1] aligned with the Expert Recommendations for Implementing Change taxonomy.[2] In Round 1, participants rated 33 implementation strategies for their usefulness in optimally implementing interdisciplinary team-based rheumatology care (from 1 [not at all useful] to 9 [extremely useful]), nominated additional strategies, and provided feedback on wording. Consensus was achieved for “useful” strategies when ≥70% of participants in both groups rated the implementation strategy as 7-9 after Round 1. Round 2 (ongoing) involves re-rating statements not achieving consensus (after reviewing group medians and quartiles) and rating strategies added. Analyses were completed overall and stratified by rheumatologists and IHPs.

Results Fifty-five rheumatology health professionals (26 rheumatologists, 29 IHPs) participated in Round 1. Rheumatologists were from Ontario (65%), the Prairies (19%), British Columbia (8%), Quebec (4%), and the Atlantic (4%); most practiced for 10-19 years (39%) in a fee-for-service model (55%). IHPs consisted of physiotherapists, occupational therapists, nurses, pharmacists, physician assistants, and chiropractors from Ontario (76%), the Prairies (14%), the Atlantic (7%), and British Columbia (4%); most practiced for ≥20 years (59%) and were salaried (90%). After Round 1, consensus was achieved for 25 implementation strategies (76%) (Table 1), with 5 additional strategies proposed by participants for subsequent rating. The highest rated implementation strategies reaching consensus were in the categories: support clinicians (constructing IHP roles, shared communication mechanisms, identifying champions), clinic space (shared electronic medical record), external needs (funding for implementation and sustainment), and training (by rheumatologists, mentorship).

Conclusion Twenty-five implementation strategies reached consensus after Round 1. Canadian rheumatology health professionals agreed that support and training for clinicians, shared team communication mechanisms, and access to sustainable funding were the most useful implementation strategies for optimal team-based rheumatology care. Results of this study will be used in a future co-design study with patients, clinicians, researchers, and organization/policy representatives to operationalize core and adaptable implementation strategies, including feasibility and contextual considerations, to develop an overall implementation approach.

References [1.] King L. J Rheum 2025;52 Suppl 2:101. [2.] Powell B. Implement Sci 2015;10:1-14.