Evaluating Implementation Context to Prepare for Scaling Up the Integration of Interdisciplinary Healthcare Providers in Rheumatology Practices: A Rheumatology Workforce Survey.

Abstract

Interdisciplinary healthcare providers (IHPs) can support effective delivery of optimal rheumatology care. To inform widespread implementation efforts, we assessed rheumatology workforce characteristics and determinants of integrating of IHPs within rheumatology practices in Ontario, Canada. A convergent mixed methods design included an environmental scan to identify clinically active rheumatologists and a workforce survey guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Quantitative data were analyzed descriptively and stratified by subgroups. Qualitative responses were analyzed using conventional content analysis. Integration of findings enabled a comprehensive understanding of implementation determinants. Of the 293 Ontario rheumatologists identified by the environmental scan (as of 2025), 26 were nearing retirement, leaving potentially 267 eligible for the survey. One hundred ninety-seven rheumatologists participated in the survey, yielding a response rate of 74% and coverage of > 90% of practice sites. Pediatric rheumatologists and those in hospital-based settings had more structural and collaborative supports than community-based rheumatologists. Overall, 177 (91%) indicated they were interested in adding IHPs, with 126 (65%) preferring an extended role/scope provider. Although inadequate funding was the key deterrent to adoption, motivational readiness was high: 92% perceived an IHP team-based model as an improvement, 86% saw it as a good fit, and 83% considered it a priority to better meet patient needs. Many noted a lack of supportive climate, including that of resources and processes, to enable this practice change. Rheumatologists report high motivation for practice change to integrate IHPs. System- and practice-level implementation strategies are needed to support workforce transformation.