Hans Philipsen

The development of a short generic version of the sickness impact profile

This study concerns the development of a short version of a well-known and much used clinimetric instrument called the Sickness Impact Profile (SIP). The SIP is a generic measure of functional status. Based on findings of a principal components analysis of over 800 SIPs from a multi-diagnostic population, a selection of 68 items divided over 6 dimensions was made and initially tested. As no support was found for the statistical validity of the categorical structure of the original SIP, a new structure, discovered through principal components analysis, was used as the basis for selecting items. Comparison of the scores on the selection with information provided by the original SIP showed very promising results: the 68 item selection may serve as a valid short SIP-version.

Assessing the responsiveness of a functional status measure: The sickness impact profile versus the SIP68

In this study, the Sickness Impact Profile (SIP) and the SIP68 are studied for their ability to detect changes in health-related behavioral status. Methodological approaches toward responsiveness are invented and discussed. Next, literature findings on the responsiveness of the SIP are presented and judged for their validity. The SIP appeared to be able to demonstrate changes in the expected direction and in accordance with changes detected by other instruments. Using data from seven different longitudinal projects in populations with different diagnoses, the responsiveness of both the SIP136 and the SIP68 are subsequently studied and compared. In all populations, changes in functional status were indicated by both instruments. In terms of effect sizes, the SIP136 and the SIP68 do not differ significantly in their responsiveness. Moreover, changes detected by both SIPs appear to be valid representations of changes in health-related functional status.

The Competing Demands of Paid Work and Parent Care Middle-Aged Daughters Providing Assistance to Elderly Parents

This article investigates the potentially competitive relationship between paid work and parent care provided by daughters and daughters-in-law. In line with the scarcity hypothesis of role theory, four subhypotheses were formulated and tested empirically. In a population-based probability sample of middle-aged women (n = 581), only partial empirical support was found for the scarcity or role conflict hypothesis. It appeared that employment significantly reduces the chances of becoming a caregiver. However, parent care and employment are not conflicting in time as the amount of care provided to parents was not affected by out-of-home employment. Parent care has only a small impact on work decisions, and employed caregivers do not experience more caregiver role strain. It was hypothesized that employed women not yet providing care anticipate a role conflict when a parent becomes frail and needs help. Consequently, a self-selection process takes place whereby the nearest living daughter with the least competing demands is most likely to accept the caregiver role. Once the caregiver role is accepted, both role strain and the time spent on parent care are determined by factors other than employment status or work hours.

Validity testing of the Dutch translation of the appraisal of the self-care agency A.S.A.-scale

The purpose of this study was translation and construct validity testing of the appraisal of the self-care agency ASA-scale. This scale measures operability of self-care agency. The original English version of the scale was translated into Dutch. Subsequently the Dutch version was retranslated into English and compared with the original for semantic and cross-cultural differences. Construct validity of the translated scale was tested on 140 elderly in the Netherlands. The scale was administered to 40 randomly selected patients of a nursing home, 30 residents of a personalized care facility, 30 residents of a service flat and 40 randomly selected elderly who lived independently in the adjacent community. As hypothesize, mean ASA scores of the four groups of elderly differed significantly. The less dependent on institutionalized nursing care the higher the operability of the self-care agency scores of the elderly.

Coordination of care : effects on the continuity and quality of care

Chronically ill elderly clients in three communities in the Netherlands were provided with the services of care coordinators. Two studies were performed to evaluate the effects of this intervention. A study among 38 coordinators addressed the effects on the continuity of care. A second study among 72 elderly clients addressed the effects on client satisfaction. While the study among coordinators clearly revealed effects on continuity (especially for interpersonal continuity), hardly any effects on satisfaction with care were reported by clients. Therefore, the appointment of care coordinators seems valuable when aimed at increasing continuity, but other interventions can be more appropriate for the improvement of client care.

Women of a middle generation and parent care.

This article addresses women who are caring for both parents and children, the so called sandwich generation or women-in-the-middle. Gerontological studies on this topic reflect controversies on the concept as well as on the size of the phenomenon. Our study attempts to demonstrate empirically to what extent middle-aged women respond to the care demands of both the generation ahead as well as the generation behind them. A population-based sample among women aged forty to fifty-four in the Netherlands (N = 933) is utilized. The study indicates the prevalence of women-in-the-middle and presents analyses of their socio-demographic characteristics as well as of patterns of parent care. Further, the potential for a cross-cultural comparison between the Netherlands and other countries is discussed regarding parent care as a normative experience and the chances of middle-aged women getting “caught” between care demands from two generations.

Plate waste producing situations on nursing wards.

This study examines the existence of a positive correlation of interferences during mealtime and the amount of plate waste. Textbooks prescribe a quiet and relaxed atmosphere. With an exploratory research design, data about the patient, his environment and plate waste were collected on a medical unit of an academic teaching hospital. Mealtime environmental conditions by no means met prescribed demands. The amount of plate waste correlated with movements made by laboratory and housekeeping personnel, visitors and physicians. Loss of appetite as well as related environmental factors are further discussed and elaborated.

Organizational and Professional Predictors of Physician Satisfaction

In order to find out whether organizational characteristics and professional attitudes are positive predictors of the job satisfaction of physicians, an analysis is presented, based on a survey of 121 internists in 13 medical departments in Dutch university hospitals. The study indicates that formal structuring of work activities is a positive predictor of work environment satisfaction, whereas size is a negative predictor. Professional attitudes such as service orientation and craftsmanship are strong positive predictors of satisfaction with patient demand. The study also indicates that certification (being a medical specialist or not) positively relates to work load satisfaction. Controlling for certification reveals that the absence of a significant relationship between formal structuring of work activities and work load satisfaction is accoun ted for by a positive correlation for medical specialists and a negative one for residents in training to become specialists. This indicates the importance of a difference in hierarchical position for the relation between formal structuring of work activities and physician satisfaction. The results for hospital physicians are consistent with satisfaction studies in other settings: dependency on bureaucratic procedures is associated with dissatisfaction, while the advantages of bureaucracy — the possibility of creating routines and procedures to limit role ambiguity — are conducive to satisfaction.

Subjective complaints and blood pressure

The relationship between blood pressure and subjective complaints concerning physical well-being has been investigated. The complaints have been measured by means of the Inventory of Subjective Health. The total number of complaints are the summation of 39 items. Hypertension is assumed to have no clear-cut symptoms. This statement gives rise to the hypothesis that there is no relationship between blood pressure and subjective complaints. The hypothesis was refuted after several tests. We found a curvilinear relationship between diastolic blood pressure and subjective complaints in representative groups of men of 21-65 and 31-50 years old, valid for the total number of complaints and dizziness. This curvilinear relationship is found again after a matching procedure in order to exclude possible confounding effects of age, cigarette smoking and knowledge about elevated blood pressure status. The total number of complaints of males with a diastolic pressure higher than 95 mmHg are not significantly higher than the total number of complaints of males with a lower diastolic pressure, but the difference is significant for dizziness.

MODERNIZATION, RATIONALITY AND CONTINUITY OF CARE: THEORETICAL CONCEPTS AND EMPIRICAL FINDINGS*

Modernization theories of Weber, Parsons, Mannheim, Elms and Habermas are used to analyze continuity of care. Discontinuities are considered unintended consequences of formal rationality and differentiation in health care, leading to a fragmented, disease-oriented health care system. It is argued that value conflicts exist between instrumental values like efficiency, effectiveness and justice ? and expressive values like continuity, solidarity, well-being and meaningfulness. This is especially the case in the care of chronically ill patients, who are in need not only of rational, systems-oriented professional interventions, but also of activities that help them establish their identities and live meaningful lives. A paradigm is presented of patient problems, strategies of care givers, ideal patient outcomes and criteria to evaluate these. Also, a research model is presented based on a continuity of care research program. JL/ue to technological innovation, scientific discovery and professionalization, modern health care has become a major institution in Western societies and a typical example of what has been achieved under the impact of rationalization (Ritzer and Walczak 1988). One of the paradoxes of modern health care, however, is related to its success. While a strong emphasis on rationality has led to a highly efficient and effective health care system, it also has become episodic and disease-oriented instead of patient-oriented. An inherent value conflict exists in health care: The pursuit of effi ciency and effectiveness with its emphasis on diagnosis and medical intervention con flicts with the need of continuity of care for people who suffer from a chronic or degenerative disease. Contradictions exist between the development of highly special ized, fragmented health care systems and the care for patients who are in need of health care that is continuous, integral and meaningful ? and which preferably can be delivered at home. Paradoxically, with the technological advancement of the health care sector, discontinuities in care will increase and are becoming a major problem for health care delivery in modern societies.