English title dissertation Continuity of care and client satisfaction in the community : a study of professional and non-professional care for the chronically ill
Name PhD (surname first) van Achterberg, Theo
Doctor is (has been) nurse
Date of promotion 17/01/1997
University Universiteit Maastricht
Promotores Prof.dr. H. Philipsen, Prof.dr. H.F.J.M. Crebolder
Abstract (English)

This thesis describes two studies that focussed on community care for those who are chronically ill or care-dependent. In both studies, community care was not restricted to the care that is provided by professionals. Informal or non-professional care, given by members from the client's social network was seen as an essential part of total community care. Whereas the first study describes the implementation and the effects of coordination of care, the
second studies addresses correlates of the diversity of care and (the course of) client satisfaction. The overall research model was derived from a combination of (theoretical) insights. Alter & Hage's Conceptual Framework for Studying Interorganizational Networks provided the framework for this model (Alter & Hage 1993). The concepts within the model were derived from the works of Andersen (1995), litwak (1985), and Wall (1981). Coordination of care, predisposing, enabling and need factors, diversity of care, care-tasks, continuity
of care and client satisfaction are the building blocks of the research model.
From study I conclusions were drawn with regard to the effects of the appointment of care-coordinators. Whereas results from coordinator interviews confirmed the proposed relationship between coordination and continuity of care, effects on the diversity of care were not identified as a result from the coordination of care intervention. It is suggested that the absence of effects on the diversity of care could result from the nature or the incompleteness of the intervention. Nevertheless, the appointment of care-coordinators is seen as beneficial, when aiming at the improvement of the continuity of care.
From the second study it was concluded that predisposing, enabling and need factors were useful in the explanation of diversity of care. Still, adding the concept of 'care-tasks' should be considered when developing a model that aims at an explanation of the variety in the diversity of professional and non-professional community care. While some effects of predisposing, enabling and need factors were reported, these factors were relatively unimportant in the explanation of (developments in) client satisfaction. Continuity of care aspects were very relevant to both the level of, and developments in client satisfaction. Although the diversity of care is relatively unimportant in the explanation of current levels of satisfaction, increasing diversity of care is a serious threat to the level of client satisfaction.
The results from study I implied that both professionals and non-professionals are suitable candidates for the role of care-coordinator. However, future interventions should give more attention to training potential coordinators in systematic working. With regard to the training of non-professionals, some additional assertiveness training and learning strategies in mobilizing other care-givers can be appropriate. Whereas the appointment of care-coordinators can result in improved continuity of care, interventions that involve formal arrangements and/or client budgets might be more effective when aiming at the improvement of client care.
Findings from the second study implied that care-givers should pay more attention to potential care deficits in the 'frail' elderly, clients who are older, live alone, are more impaired and report a relatively low quality of life. Furthermore, the results for this study further revealed that client satisfaction scores are meaningful and that the level of client satisfaction is threatened by a high complexity of care. Therefore, coordination of care is all the more relevant in situations with a high diversity of care.