• Anna Zogas, Chris Gillespie, Felicia Kleinberg, Joel I Reisman, Ndindam Ndiwane, Michael H Tran, Heather L Ourth, Anthony P Morreale, Donald R Miller, and Megan B McCullough.
• From the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, MA (AZ); Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, MA (CG, FK, JIR, NN, DRM, MBM); Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC (MHT, HLO, APM); University of Massachusetts, Lowell, Center for Population Health (DRM); University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health (MBM).
• J Am Board Fam Med. 2021 Mar 1; 34 (2): 320-327.

BackgroundWith the restructuring of primary care into patient-centered medical homes (PCMH), researchers have described role transformations that accompany the formation of core primary care teamlets (eg, primary care provider, registered nurse care manager, licensed practical nurse, medical support assistant). However, few studies offer insight into how primary care teamlets, once established, integrate additional extended team members, and the factors that influence the quality of their integration.MethodsWe examine the process of integrating Clinical Pharmacy Specialists (CPS) into primary care teams in the Veterans Health Administration (VHA). We conducted semi-structured interviews with CPS (n = 6) and clinical team members (n = 16) and performed a thematic analysis of interview transcripts.ResultsWe characterize 2 ways CPS are integrated into primary care teamlets: in consultative roles and collaborative roles. CPS may be limited to consultative roles by team members' misconceptions about their competencies (ie, if CPS are perceived to handle only medication-related issues like refills) and by primary care providers' opinions about distributing responsibilities for patient care. Over time, teams may correct misconceptions and integrate the CPS in a more collaborative role (ie, CPS helps manage disease states with comprehensive medication management).ConclusionsCPS integrated into collaborative roles may have more opportunities to optimize their contributions to primary care, underscoring the importance of clarifying roles as part of adequately integrating advanced practitioners in interprofessional teams.© Copyright 2021 by the American Board of Family Medicine.

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