Document Type


Date of Degree

Fall 2013

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Doucette, William R

First Committee Member

Carter, Barry L

Second Committee Member

Urmie, Julie M

Third Committee Member

Vander Weg, Mark W

Fourth Committee Member

Vaughn, Thomas E


In the modern society, chronic diseases have become the leading causes of death. With early recognition and proper management, however, many of the complications from chronic diseases could be prevented or delayed. Taking such a proactive approach in managing a population often requires the use of team-based approaches and delegation of certain clinical and nonclinical tasks to nonphysician team members. This three-study dissertation used a combination of methods to explore contextual factors that influence primary care teamwork and physician-pharmacist collaboration. The first study quantitatively examined baseline barriers and facilitators of physician-pharmacist collaboration in clinics participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial. Pharmacist expertise and clinic staff support were found to be the most important facilitators for physicians, while insurance reimbursement and task design factors were important for pharmacists. The second study characterized clinic personnel experience participating in the CAPTION trial and explored determinants of disease state control. Higher proportions of indigent and minority populations and higher baseline pharmacy structure scores were found to be associated with lower blood pressure control. The third study qualitatively examined organizational influences on primary care team effectiveness and the roles of pharmacists in a separate sample of primary care clinics. A lack of organizational rewards for teamwork in primary care was identified and pharmacists were integrated into clinic workflow in various degrees. These findings will be informative for practice managers and health care professionals seeking to redesign their practice to meet increasing needs of patients with chronic diseases.


Ambulatory care, Multiple-case study, Organizations, Pharmacists, Practice-based research network, Primary care


vii, 217 pages


Includes bibliographical references (pages 196-217).


Copyright © 2013 Elizabeth H. Chang