Guidelines for pharmacists integrating into primary care teams.

Health systems are moving toward a more interprofessional approach to primary care. This team-based paradigm has had a significant impact on the role of pharmacists within primary health care systems. Within the past decade, nondispensing clinical pharmacists have been integrated into many Primary Care Trusts in the United Kingdom,1,2 primary care teams in North America3-5 and similar practice settings around the world.6,7 Pharmacists bring value to these teams by improving medication use through individual patient assessments and population-based interventions, providing education and drug information to other team members and implementing system-level practice enhancements.3 Pharmacists commonly encounter barriers to integrating into these primary care teams. For example, many experience a lack of role clarity, and other team members’ expectations regarding the pharmacists’ responsibilities are frequently unclear.4,8-11 In addition, patients often do not understand the role of the pharmacist in this setting.9,10,12 Pharmacists are also typically unfamiliar with the roles of other team members,13 creating difficulties in collaborating successfully.14-16 During the early stages, pharmacists often depend on other team members to assist in their integration, creating additional work for nurses and physicians.17 Other frequently reported barriers include physician resistance, lack of pharmacist assertiveness, inadequate pharmacist support, lack of space and inadequate pharmacist training.9-11,13,14,17-21 Many of these barriers to pharmacist integration can be minimized or avoided if pharmacists are prepared. Unfortunately, recent evidence suggests that pharmacists often continue to make the same mistakes and struggle to integrate into these teams, despite the fact that these barriers are well documented in the literature.22 The purpose of these guidelines is to provide recommendations that will assist pharmacists to successfully integrate into existing primary care teams.