Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

Background: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of nonadherence varied across studies: 2.6 1353% for dialysis exchanges, 3.9 1385% for medication, and 14.4 1367% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient populatio

Managing the Unwanted: Medical Errors in Primary Care

Medical errors can potentially induce adverse consequences of death, permanent disability, psychological distress, or financial impact for patients, health care professionals, and health care organizations. The seminal report To Err is Human catalyzed the patient safety movement two decades ago, and safety in primary care has now emerged as a priority. This dissertation comprises three empirical studies that investigated how health care professionals and managers in primary care organizations approach patient safety and medical errors. Using interview and focus group data collected from a total of 166 informants across 10 Patient-Centered Medical Homes (PCMH) in four states, the first study is a qualitative investigation of the conceptual meanings of patient safety by front line clinicians, administrators, staff, and patients. It reveals four overarching principles and work functions, which should be considered in patient safety activities in primary care in addition to existing conceptualizations that are more expert-driven. The second study uses the same qualitative interview data to examine how high-performance primary care organizations like PCMHs address errors that may occur in the future. I find that health care professionals and managers anticipate errors through omission-based thinking, which in turn leads to a set of informational search strategies to help them manage errors prospectively. The findings led to a proposed comparative organizational model for prospective error management to help us better understand the organizational factors that can shape patient safety performance. The third study is an experiment that used a pilot sample of 58 primary care physicians to test how the error attributes of severity, frequency, and concentration interact to affect the way errors are identified and addressed (or not). I find that among these error attributes being tested, frequency has an independent effect on errors to be highlighted for organization action and seen as urgent. This also suggests that errors that are severe and/or concentrated may be under-detected, under-reported, and under-addressed. Collectively, these studies demonstrate the utility of integrating perspectives from organization science, especially from the areas of organizational cognition and organizational errors, into patient safety research

Managing the Unwanted: Medical Errors in Primary Care

Medical errors can potentially induce adverse consequences of death, permanent disability, psychological distress, or financial impact for patients, health care professionals, and health care organizations. The seminal report To Err is Human catalyzed the patient safety movement two decades ago, and safety in primary care has now emerged as a priority. This dissertation comprises three empirical studies that investigated how health care professionals and managers in primary care organizations approach patient safety and medical errors. Using interview and focus group data collected from a total of 166 informants across 10 Patient-Centered Medical Homes (PCMH) in four states, the first study is a qualitative investigation of the conceptual meanings of patient safety by front line clinicians, administrators, staff, and patients. It reveals four overarching principles and work functions, which should be considered in patient safety activities in primary care in addition to existing conceptualizations that are more expert-driven. The second study uses the same qualitative interview data to examine how high-performance primary care organizations like PCMHs address errors that may occur in the future. I find that health care professionals and managers anticipate errors through omission-based thinking, which in turn leads to a set of informational search strategies to help them manage errors prospectively. The findings led to a proposed comparative organizational model for prospective error management to help us better understand the organizational factors that can shape patient safety performance. The third study is an experiment that used a pilot sample of 58 primary care physicians to test how the error attributes of severity, frequency, and concentration interact to affect the way errors are identified and addressed (or not). I find that among these error attributes being tested, frequency has an independent effect on errors to be highlighted for organization action and seen as urgent. This also suggests that errors that are severe and/or concentrated may be under-detected, under-reported, and under-addressed. Collectively, these studies demonstrate the utility of integrating perspectives from organization science, especially from the areas of organizational cognition and organizational errors, into patient safety research

Work Hard, Snore Hard: Recovery from Work for Early Career Researchers

Being an early career researcher often means having to work intensely on projects and articles. Periods with heavy workloads are common, and proper recovery during breaks or after work can sometimes not take place because of limited time. As prolonged periods of intense work with little rest may lead to long-term negative effects, this chapter discusses the importance of recovery and several actionable tips to consider for early career researchers. We begin with a brief personal example that illustrates why sufficient rest is needed. Next, we introduce recovery from work concepts. We explain that optimal recovery from work on a daily basis is necessary to offset negative long-term effects such as fatigue and burnout. Based on research in occupational health psychology, we provide several practical tips on how to recover well and overcome challenges related to recovery from work. The aim is to help early career researchers in preventing exhaustion or eventually burnout, so they can keep doing their work in a sustainable way.keywordsrecovery from workrecovery experiencessleepearly career researchermental health

To Come, to See, to Conquer: Practical Pointers in Applying for Funding and Securing Your Initial Grants

Obtaining your doctorate degree not only implies that you are able to design and conduct rigorous scientific research independently but also that you are expected to be able to get your projects funded. Your ability to acquire research funds can have large implications for the type of research questions you can pursue, the articles you can publish, the societal impact you can have with your work, and whether or not you will get a permanent position. Therefore, applying for funding can be one of the most daunting aspects of being an early career researcher. In this chapter, we reflect on our attempts at acquiring funding as early career researchers for the past five years of our careers. We share some lessons we have learned during this bumpy road, which was filled with (many) rejected and (some) successful grant applications. We hope that these will help early career scholars to feel more prepared for their own funding endeavors.keywordsfundinggrantseffective writingpeer-reviewfunding bodies

Being "low on the totem pole":What makes work worthwhile for medical assistants in an era of primary care transformation

BACKGROUND: Primary care is undergoing a transformation to become increasingly team-based and multidisciplinary. The medical assistant (MA) is considered a core occupation in the primary care workforce, yet existing studies suggest problematic rates and costs of MA turnover. PURPOSE: We investigated what MAs perceive their occupation to be like and what they value in it to understand how to promote sustainable employability, a concept that is concerned with an employee's ability to function and remain in their job in the long term. APPROACH: We used a case of a large, integrated health system in the United States that practices team-based care and has an MA career development program. We conducted semistructured interviews with 16 MAs in this system and performed an inductive analysis of themes. RESULTS: Our analysis revealed four themes on what MAs value at work: (a) using clinical competence, (b) being a multiskilled resource for clinic operations, (c) building meaningful relationships with patients and coworkers, and (d) being recognized for occupational contributions. MAs perceived scope-of-practice regulations as limiting their use of clinical competence. They also perceived task similarity with nurses in the primary care setting and expressed a relative lack of performance recognition. CONCLUSION: Some of the practice changes that enable primary care transformation may hinder MAs' ability to attain their work values. Extant views on sustainable employability assume a high bar for intrinsic values but are limited when applied to low-wage health care workers in team-based environments. PRACTICE IMPLICATIONS: Efforts to effectively employ and retain MAs should consider proactive communications on scope-of-practice regulations, work redesign to emphasize clinical competence, and the establishment of greater recognition and respect among MAs and nurses

Delivering High-Quality Primary Care Requires Work That Is Worthwhile for Medical Assistants

Medical assistants are core members of the primary care team, but health care organizations struggle to hire and retain them amid the ongoing exodus of health care workers as part of the "Great Resignation." To sustain a stable and engaged workforce of medical assistants, we argue that efforts to hire and retain them should focus on making their work worthwhile. Work that is worthwhile includes adequate pay, benefits, and job security, but additionally enables employees to experience a sense of contribution, growth, social connectedness, and autonomy. We highlight opportunities during team huddles, the rooming of patients, and career development where the work of medical assistants can be made worthwhile. We also connect these components to the work design literature to show how clinic managers and supervising clinicians can promote worthwhile work through decision-making and organizational climate. Going beyond financial compensation, these components target the latent occupational needs of medical assistants and are likely to forge employee-employer relationships that are mutually valued and sustained over time