Facilitators and Barriers to Implementing a Remote Monitoring Model of Care for Stable Patients With Axial Spondyloarthritis Using the Consolidated Framework for Implementation Research: Qualitative Study

Background: Close follow-up of stable patients with axial spondyloarthritis (axSpA) presents a financial burden and inconvenience to patients. A remote monitoring patient-reported outcome measures (PROMs)-based model of care (PROMise) was designed to reduce the frequency of in-person consultations for stable patients with axSpA. However, little is known about the facilitators and barriers of implementing a remote monitoring PROMise. Objective: This study aims to understand the facilitators and barriers, as well as the mitigation strategies to implementing a PROMise in the Singapore context. Methods: We conducted a qualitative study involving in-depth interviews with 19 patients with axSpA (78.9% (15) male, mean age 39.4, SD 11.7 years) and 13 health care professionals (HCPs) (23.1%, 3 male; mean age 37.9, SD 7.2 years) in a tertiary hospital in Singapore until data saturation was reached. Participants were purposively recruited based on sex, age, and ethnicity. Patients were additionally recruited based on the number of years since diagnosed with axSpA, while HCPs were recruited based on seniority and their role in the care of patients with axSpA. Interviews were transcribed, deductively analyzed, and mapped to the Consolidated Framework for Implementation Research (CFIR) framework to identify facilitators and barriers from both the patients' and HCPs' perspectives. The CFIR-Expert Recommendations for Implementing Change (ERIC) match tool was used to produce implementation strategies to overcome the CFIR barriers identified. Results: All five domains of the CFIR framework were elicited. Facilitators included (1) reduced inconvenience and costs for patients and reduced patient load in the clinic, (2) need for PROMise, (3) similarity to current workflows, and (4) suitable patient selection. Barriers included concerns for (1) financial sustainability of PROMise, (2) cultural conditions, (3) patient safety, and (4) increased workload for HCPs. In total, 35 ERIC strategies were matched to the corresponding CFIR barriers. Conclusions: We identified ERIC strategies that will facilitate the implementation of the PROMise model. In particular, focus should be placed on developing an implementation blueprint and obtaining continuous feedback from affected patients with axSpA and HCPs involved in the care of the affected patients. These implementation strategies cross-cut the CFIR barriers identified and thus may overcome the barriers to implementation.