Clinical pharmacy practitioners’ semi-visible labor: building referral relationships in interprofessional collaborative care

ABSTRACT

Clinical pharmacy practitioners (CPP) in the Veterans Health Administration (VHA) prescribe medications and help manage chronic conditions such as diabetes, and they are increasingly working as part of interprofessional clinical teams. The challenges of integrating a new role in a clinical team are documented, but we know less about strategies new healthcare providers use to overcome these challenges. We studied how clinical pharmacy practitioners integrated into clinical teams. We conducted telephone interviews with clinical pharmacy practitioners (n = 53) and members of their clinical teams (n = 74), which were recorded, transcribed, and coded for concepts and themes. We identified four major themes. We found CPP perceived VHA as a “safe haven” for interprofessional care but found it necessary to build other prescribers’ trust and confidence in their clinical skills to establish the referral relationships they needed for full integration. To facilitate their integration, CPP engaged in relational, untracked labor, which we characterize as semi-visible labor. While both CPP and clinical team members perceived CPPs’ semi-visible labor as vital for implementing and maintaining strong interprofessional collaborations, such labor may be unsustainable as a long-term strategy for integrating CPP in clinical teams.

KEYWORDS:

• Advanced practice providers
• clinical pharmacy practitioners
• integration
• role
• semi-visible labor
• Veterans Health Administration

Acknowledgments

The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the US government. The authors gratefully acknowledge the generosity and time of the clinical pharmacy practitioners and clinical team members who participated in this evaluation. We also thank two anonymous peer reviewers whose critical feedback helped improve this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the US Department of Veterans Affairs Office of Rural Health and the Clinical Pharmacy Practice Office of the Pharmacy Benefits Management Service, though the Office of Rural Health’s Enterprise-Wide Initiative, OMAT ID: 6119. Anna Zogas’ work and the writing of this manuscript were supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research.

Notes on contributors

Anna Zogas

Anna Zogas is an anthropologist and health services researcher at the Center for Healthcare Organization and Implementation Research at the VA Boston Healthcare System.

Chris Gillespie

Chris Gillespie is a sociologist and health services researcher at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System.

Felicia Kleinberg

Felicia Kleinberg is a licensed clinical social worker and project manager at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System.

Joel Reisman

Joel I. Reisman is a programmer-analyst at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System.

Ndindam Ndiwane

Ndindam Ndiwane is a statistician at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System.

Michael Tran

Michael H. Tran is a pharmacist serving as National Program Manager at the VA Pharmacy Benefits Management Clinical Pharmacy Practice Office, Department of Veterans Affairs.

Heather Ourth

Heather L. Ourth is a pharmacist serving as Assistant Chief Consultant at the VA Pharmacy Benefits Management Clinical Pharmacy Practice Office, Department of Veterans Affairs.

Anthony Morreale

Anthony P. Morreale is a pharmacist serving as Associate Chief Consultant for Clinical Pharmacy and Policy at the VA Pharmacy Benefits Management Clinical Pharmacy Practice Office, Department of Veterans Affairs.

Donald Miller

Donald R. Miller is an epidemiologist and health services researcher who is affiliated with the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System. He is currently a Research Professor at the University of Massachusetts at Lowell in the Center for Population Health and is senior epidemiologist for the national VA Medication Safety Center.

Megan McCullough

Megan B. McCullough is an anthropologist and health services researcher at the Center for Healthcare Organization and Implementation Research at the VA Bedford Healthcare System.