JMIR Publications

ABSTRACT

Background:

Close follow up of stable patients with axial spondyloarthritis (axSpA) presents both 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 PROMs based model of care.

Objective:

To understand the facilitators and barriers of implementing a PROMs based model of care (PROMise) in the Singapore context.

Methods:

We conducted a qualitative study involving in-depth interviews with 19 patients with axSpA (78.9% male, mean age 39.4 years) and 13 healthcare professionals (HCPs) (23.1% male, mean age 37.9 years) in a tertiary hospital until data saturation was reached. Interviews were transcribed, deductively analysed 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 utilised to produce implementation strategies to overcome the CFIR barriers identified.

Results:

All 5 domains of the CFIR framework were elicited. Facilitators included 1a) reduced inconvenience and costs for patients, 1b) reduced patient load in the clinic, 2) need for PROMise, 3) similarity to current workflows, 4) suitable patient selection. Barriers included concerns for 1) financial sustainability of PROMise, 2) cultural conditions, 3) patient safety, 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 of care. 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.