Form Survey of Clinic M Survey of Clinic M Survey of Clinic Medical Directors- Pharm

Medical Directors Survey

Pharmacy Sites

May 2005

1. Please make any corrections to the label below.

2. What is your title within this organization?

3. What is your discipline?

MARK (X) ONE ANSWER

1 ¨ Physician (MD or DO)

2 ¨ Dentist (DDS/DMD)

3 ¨ Physician assistant

4 ¨ Nurse practitioner

5 ¨ Certified Nurse midwife

6 ¨ Registered nurse

7 ¨ Chiropractor

8 ¨ Pharmacist

9 ¨ Other (Specify)

4. When did you begin working for this organization?

Month: Year:__________

5. Direct patient care includes face-to-face contact with patients, as well as patient record-keeping, travel time connected with seeing patients, and communication with other physicians, hospitals, pharmacies, and other places on a patient’s behalf.

Do you currently provide direct patient care?

1 ¨ Yes

2 ¨ No GO TO Q6

A. (If you provide direct patient care) During a typical week, approximately what percentage of your work time is spent in direct patient care activities?

Percentage of time in direct patient care

6. Which of the following categories best describes the ownership of this clinic?

MARK (X) ONE ANSWER

¨ A group practice

¨ A nonprofit community-based care clinic (run by a nonprofit board of directors)

¨ A community-based primary care clinic run by the health department or other government agency

¨ A community-based primary care clinic run by a hospital

¨ A community-based primary care clinic run by a university medical center

¨ Other (Specify)

7. How many clinics are in your network?

Number of clinics

8. If this is a multi-site network, please answer the remaining questions only for this site.

At this site, how many patient visits do you have in a typical week?

Number of patient visits in a

typical week

9. Please record (1) the number of full-time equivalent (FTE) staff and (2) the number of current job openings for each of the clinician categories in this site.

Please include MD’s and DO’s in each physician category. Include both NHSC and non-NHSC clinicians.

Clinician Type	(1) Number of Current FTE Staff	(2) Number of Job Openings
1. General and Family Practitioner
2. General Internist
3. Pediatrician
4. OB/GYN
5. Psychiatrist
6. Other physician specialists
7. Dentist
8. Dental hygienist
9. Physician Assistant
10. Nurse Practitioner
11. Certified Nurse Midwife
12. RN and LPN
13. Chiropractor
14. Physical Therapist
15. Registered Pharmacist
16. Pharmacy Technician
17. Mental Health Provider (other than psychiatrists)
18. Other clinical personnel (Specify)

10. Does this site have any NHSC clinical staff or job openings for NHSC clinicians at this time?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q12, PAGE 5

11. For each of the clinician categories listed below, record the number of full-time equivalent (FTE) NHSC clinicians on your staff at this site.

Clinician Type	Current Number of NHSC Staff in FTEs
1. General and Family Practitioner
2. General Internist
3. Pediatrician
4. OB/GYN
5. Psychiatrist
6. Dentist
7. Dental hygienist
8. Physician Assistant
9. Nurse Practitioner
10. Certified Nurse Midwife
11. Chiropractor
12. Registered Pharmacist
13. Mental Health (other than psychiatrists)
14. Other clinical personnel (Specify)

12. In the last three years, have you offered a position to a pharmacist to work at this site?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q14

12a. Thinking about the last time you decided to offer a position to a pharmacist at this site, did you consult with any other clinicians?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q14

13. Which of the following types of clinicians did you consult with before deciding to offer a position to the pharmacist?

MARK (X) ALL THAT APPLY

1 ¨ Physician (MD or DO)

2 ¨ Physician assistant

3 ¨ Nurse practitioner

4 ¨ Certified nurse midwife

5 ¨ Registered nurse

6 ¨ Other chiropractor already on staff

7 ¨ Pharmacist

8 ¨ Other

14. How are pharmacy services currently provided at this site?

MARK (X) YES OR NO FOR EACH ITEM

	Yes	No
On-site pharmacy	1 ¨	0¨
Contracted pharmacy services	1 ¨	0¨
Mail-order pharmacy	1 ¨	0¨
Provider dispensing	1 ¨	0¨
Rebate	1 ¨	0¨
Other:	1 ¨	0¨

15. How many prescriptions have been dispensed to patients at this site? If you have this information for 2004 or for your last fiscal year, please record it. If not, estimate the number of prescriptions dispensed in a typical week or month.

MARK (X) FOR THE TIME PERIOD YOU SELECTED AND RECORD THE NUMBER DISPENSED.

¨ NUMBER DISPENSED IN 2004

OR

¨ NUMBER DISPENSED IN

LAST FISCAL YEAR

OR

¨ NUMBER DISPENSED IN

A TYPICAL MONTH

OR

¨ NUMBER DISPENSED IN

A TYPICAL WEEK

16. Does this site have a registered pharmacist on staff?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q24, PAGE 10

17. Which of the following services are provided by registered pharmacists employed at this site?

MARK (X) YES OR NO FOR EACH ITEM REVISED

	Yes	No
DISPENSING MEDICATIONS:
Prepare the prescription orders	1 ¨	0 ¨
Transfer the medications to patients	1 ¨	0 ¨
PATIENT COUNSELING:
Providing written information with each new prescription	1 ¨	0 ¨
Oral counseling with each filled prescription	1 ¨	0 ¨
Individual counseling for specific conditions	1 ¨	0 ¨
Group counseling for specific conditions	1 ¨	0 ¨
DRUG UTILIZATION REVIEW:
Checking patient records to ensure patient still needs medication	1 ¨	0 ¨
Checking patient records to ensure dosage is appropriate	1 ¨	0 ¨
Checking patient records for adverse drug reactions and interactions	1 ¨	0 ¨
CONSULTATIVE AND EDUCATIONAL SERVICES FOR PROVIDERS:
Consulting with other health providers within the clinic	1 ¨	0 ¨
Consulting with other health providers at other sites within your clinic’s network	1 ¨	0 ¨
Consulting with health providers outside the clinic	1 ¨	0 ¨
Educating providers (in-service sessions, grand round sessions, sharing information from drug representatives)	1 ¨	0 ¨
PHARMACY MANAGEMENT:
Management of pharmacy operations	1 ¨	0 ¨
Formulary management	1 ¨	0 ¨
Drug utilization review	1 ¨	0 ¨

18. Where do prescription orders to the pharmacy staff in this site come from most frequently?

MARK (X) ONE ANSWER

1 ¨ Other clinic staff at this site

2 ¨ Staff from other sites in the clinic network

3 ¨ Providers from outside the clinic network

4 ¨ Prescription orders are not filled at this clinic

19. At this site, who transfers prescription medications to patients?

MARK (X) ALL THAT APPLY

1 ¨ Registered pharmacist

2 ¨ Pharmacy technician

3 ¨ Other type of clinician (specify)

20. At this site, how often do registered pharmacists co-manage patient care with physicians?

 Always

 Usually

 Sometimes

 Rarely GO TO Q.21

 Never GO TO Q. 21

A. What types of patients are co-managed by pharmacists and physicians? (Describe below)

21. An interdisciplinary care team is comprised of three or more professionals from different care disciplines dedicated to the ongoing and integrated care of one patient, set of patients, or clinical condition. Does this clinic have any interdisciplinary care teams?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q24, PAGE 10

a. How many interdisciplinary care teams does the clinic have?

Number of teams

b. Do any of the clinic’s interdisciplinary care teams include a pharmacist?

1 ¨ Yes

0 ¨ No IF NO, GO TO Q24, PAGE 10

c. How frequently does the interdisciplinary care team that includes a pharmacist meet?

MARK (X) ONE ANSWER AND THEN GO TO Q19

1 ¨ Regularly, at least once a week

2 ¨ Regularly, at least once a month

3 ¨ Regularly, but less than once a month

4 ¨ On and ad hoc or as needed basis

22. What is the main objective of the interdisciplinary care team that includes a pharmacist?

MARK (X) ALL THAT APPLY

1 ¨ To manage the care of specific patients

2 ¨ To develop and implement process of care

protocols

3 ¨ To monitor quality of care initiatives

4 ¨ To maintain a disease management program

5 ¨ Other (describe)

23. When this site has a job opening for a clinician who usually identifies the pool of candidates?

1  On-site clinic staff

2  Other staff within the organization

When

2 4. In the last 12 months, how much of a problem, if any, has it been to recruit each of the following types of clinicians at this site?

MARK (x) FOR EACH CATEGORY. IF YOU DID NOT ATTEMPT TO RECRUIT ANYONE FROM A CLINICAL GROUP IN THE LAST 12 MONTHS, CHECK THE BOX NEXT TO “NOT RECRUITED”.

Clinician Type	Big Problem	Small Problem	Not a Problem	Not Recruited
1. Physicians (MD/DO)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
2. Dentists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
3. Dental hygienists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
4. Physician assistants	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
5. Nurse practitioners	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
6. Certified nurse midwifes	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
7. RNs and LPNs	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
8. Chiropractors	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
9. Physical therapists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
10. Pharmacists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
11. Pharmacy technicians	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited
12. Mental health providers (other than psychiatrists)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not recruited

25. In the last 12 months, how much of a problem, if any, has it been to retain each of the following types of clinicians at this site?

MARK (x) FOR EACH CATEGORY. IF YOU DID NOT EMPLOY ANYONE FROM A CLINICIAN GROUP AT THIS SITE IN THE LAST 12 MONTHS, CHECK THE BOX NEXT TO “NOT EMPLOYED”.

Clinician Type	Big Problem	Small Problem	Not a Problem	Not Employed
1. Physicians (MD/DO)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
2. Dentists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
3. Dental hygienists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
4. Physician assistants	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
5. Nurse practitioners	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
6. Certified nurse midwifes	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
7. RNs and LPNs	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
8. Chiropractors	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
9. Physical therapists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
10. Pharmacists	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
11. Pharmacy technicians	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed
12. Mental health providers (other than psychiatrists)	1 ¨ A big problem	2 ¨ A small problem	3 ¨ Not a problem	4 ¨ Not employed

26. If you could add a pharmacist to your clinic, do you think that would improve your ability to retain other clinicians or not?

1 ¨ Yes IF YES, GO TO Q26a

0 ¨ No IF NO, GO TO Q26b

2 ¨ Unsure IF UNSURE, GO TO Q27, PAGE 13

A. (If yes) Which of the following types of clinicians would be easier to retain?

MARK (X) ALL THAT APPLY

1 ¨ Physicians

2 ¨ Dentists

3 ¨ Dental hygienists

4 ¨ Physician assistants

5 ¨ Nurse practitioners

6 ¨ Certified nurse midwifes

7 ¨ RNs and LPNs

8 ¨ Chiropractors

9 ¨ Physical therapists

10 ¨ Pharmacists

11 ¨ Pharmacy technicians

12 ¨ Mental health providers (other than psychiatrists)

B. (If no) Why wouldn’t adding a pharmacist to your clinic improve your ability to retain other clinicians?

27. During the past 12 months, how much of a problem, if any, was it to obtain primary care services for patients seen at this clinic when you or your staff thought they were medically necessary?

1 ¨ A big problem

2 ¨ A small problem

3 ¨ Not a problem IF NOT A PROBLEM,

GO TO Q28

(If a big or small problem) Please rate the importance of each of the following reasons why you might not be able to obtain primary care services.

A. There aren’t enough qualified primary care providers in the area.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

B. Health plan networks and administrative barriers limit patient access.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

C. Patients lack health insurance or have inadequate insurance coverage.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

28. During the past 12 months, how much of a problem, if any, was it to obtain pharmacy services for patients seen at this clinic when you or your staff thought they were medically necessary?

1 ¨ A big problem

2 ¨ A small problem

3 ¨ Not a problem IF NOT A PROBLEM,

GO TO Q29, PAGE 14

(If a big or small problem) Please rate the importance of each of the following reasons why you might not be able to obtain pharmacy services.

A. There aren’t enough qualified pharmacists in the area.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

B. Health plan networks and administrative barriers limit patient access.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

C. Patients lack health insurance or have inadequate insurance coverage.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

29. During the past 12 months, how much of a problem, if any, was it to obtain treatment for neck or back pain for patients seen at this clinic when you or your staff thought it was medically necessary?

1 ¨ A big problem

2 ¨ A small problem

3 ¨ Not a problem IF NOT A PROBLEM,

GO TO Q30

(If a big or small problem) Please rate the importance of each of the following reasons why you might not be able to obtain services to treat neck or back pain.

A. There aren’t enough qualified providers in the area.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

B. Health plan networks and administrative barriers limit patient access.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

C. Patients lack health insurance or have inadequate insurance coverage.

1 ¨ Very important

2 ¨ Moderately important

3 ¨ Not very important

4 ¨ Not at all important

30. Who pays the salary of the NHSC pharmacist at this site?

 The clinic

 The network

 Another entity (describe)

31. If the NHSC pharmacist left the clinic, would you replace him or her with another registered pharmacist?

1 ¨ Yes

0 ¨ No Why not?

32. Please describe the impacts, if any, of the NHSC pharmacist on each of the following:

Access to care:

Patient satisfaction:

Quality of care:

Costs of care:

Utilization patterns:

Stability of clinical staff:

33. What is your age now?

MARK (X) ONE ANSWER

1 ¨ 18 to 24

2 ¨ 25 to 34

3 ¨ 35 to 44

4 ¨ 45 to 54

5 ¨ 55 to 64

6 ¨ 65 to 74

7 ¨ 75 or older

34. Are you male or female?

MARK (X) ONE ANSWER

1 ¨ Male

2 ¨ Female

35. What is the highest degree that you have completed?

MARK (X) ONE ANSWER

1 ¨ Some college or 2-year degree

2 ¨ BA or BS Degree

3 ¨ MA or MS

4 ¨ MBA or MPH

5 ¨ DC

6 ¨ PhD

7 ¨ MD, DO

8 ¨ DMD

9 ¨ PharmD

10 ¨ Other (Describe):

36. Are you of Hispanic or Latino origin or descent?

MARK (X) ONE ANSWER

1 ¨ Yes, Hispanic or Latino

2 ¨ No, not Hispanic or Latino

37. What is your race?

MARK (X) ALL THAT APPLY

1 ¨ White

2 ¨ Black or African-American

3 ¨ Asian

4 ¨ Native Hawaiian or other Pacific Islander

5 ¨ American Indian or Alaska Native

6 ¨ Other:

FOR MPR PURPOSES ONLY:

/home/ec2-user/sec/disk/omb/icr/200701-0915-004/doc/1552301

(REV—5/10/05) 2/6/2021 8:24 AM

6126 - 074

Jen revised for Richard Strouse

Prepared by Mathematica Policy Research, Inc.