Pharmacists Pretests

National Survey of Pharmacists about Pill Appearance

Thank you for taking this survey. Once again, the goal is to learn about your perspectives as pharmacists about the appearance of the prescription pills that you dispense. These changes can include pill color, shape, size, and any markings (such as text, lines, grooves, or designs) printed on the pill.

Please keep in mind:

• This survey requires no outside materials and your responses will not be linked to your personal information.

• We plan to widely disseminate the results of this survey in peer-reviewed journals. The survey is designed to take no more than 20 minutes to complete.

• The Institutional Review Board at Brigham and Women’s Hospital has approved this protocol. Your participation is voluntary.

We appreciate your contribution to this important topic.

*****************************************************************

Instructions for completing the survey:

• As you read through the survey, please answer each question based on the information provided. If you do not know or do not have an answer to a question, do not guess, just check “don't know” (if available) or move onto the next question.

• Using a blue or black pen, place an “X” in the box next to the appropriate response as shown: .

• If asked to provide a written response to a question, please PRINT legibly in the space provided.

• Note: When we say the word “pill” in this survey, we mean drugs in the form of capsules or tablets.

• As a reminder, you can also take the survey online if you prefer. The link to the online version is noted in the cover letter enclosed in the survey packet.

*****************************************************************

Please return your completed questionnaire in the enclosed postage-paid envelope. If you have misplaced the envelope, please mail your completed survey to:

Job 46563

c/o ADAPT Inc.

PO Box 5703

Hopkins, MN 55343

^{section A: Perceptions About generic pills and their appearance}

In this first set of questions, we are interested in your views on generic pills in general. This information will be used to help understand your views on the appearance of generic pills.

A1. Do you think generic pills are…?

₁ Definitely as effective as their brand-name versions

₂ Probably as effective as their brand-name versions

₃ Probably not as effective as their brand-name versions

₄ Definitely not as effective as their brand-name versions

₈ Don’t know/Not sure

A2. Do you think generic pills are…?

₁ Definitely as safe as their brand-name versions

₂ Probably as safe as their brand-name versions

₃ Probably not as safe as their brand-name versions

₄ Definitely not as safe as their brand-name versions

₈ Don’t know/Not sure

A3. Do you think generic pills…?

₁ Definitely have the same side effects as their brand-name versions

₂ Probably have the same side effects as their brand-name versions

₃ Probably do not have the same side effects as their brand-name versions

₄ Definitely do not have the same side effects as their brand-name versions

₈ Don’t know/Not sure

A4. Do you think generic pills are…?

₁ Definitely made of the same active ingredient and dose strength as their brand-name versions

₂ Probably made of the same active ingredient and dose strength as their brand-name versions

₃ Probably not made of the same active ingredient and dose strength as their brand-name versions

₄ Definitely not made of the same active ingredient and dose strength as their brand-name versions

₈ Don’t know/Not sure

A5. When you receive a prescription for a brand-name pill, and the prescription permits substitution, and the patient does not request brand-only, about how often do you fill the prescription with a generic pill?

₁ Almost always (greater than 90% of the time)

₂ Commonly (51-90% of the time)

₃ Occasionally (10-50% of the time)

₄ Rarely (less than 10% of the time)

₅ Never

A6. Among all the generic pills you carry, approximately how many times in an average month do you notice that your pharmacy has changed the manufacturer to one that has a different appearance?

₁ 0-1

₂ 2-5

₃ 6-15

₅ More than 15

A7. How often does your pharmacy, distributor, or wholesaler alert you when it changes suppliers for the generic pills it carries to one that has a different appearance?

₁ Almost always

₂ Commonly

₃ Occasionally

₄ Rarely

₅ Never

The next series of questions is about pill appearance. Pill appearance includes the pill’s color, shape, size, as well as the pill’s markings (such as text, lines, grooves, or designs).

A8. Which of the following best describes your preference as to the appearance of the generic pills you dispense?

₁ I much prefer my pharmacy to dispense generics with the same appearance as the brand-name

₂ I somewhat prefer my pharmacy to dispense generics with the same appearance as the brand-name

₃ I have no preference as to whether my pharmacy dispenses generics with the same appearance as the brand-name

₄ I somewhat prefer my pharmacy not dispense generics with the same appearance as the brand-name

₅ I much prefer my pharmacy not dispense generics with the same appearance as the brand-name

₆ Don’t know/Not sure

A9. How likely is it that DIFFERENCES in appearance among different manufacturers’ versions of the same pill (generic/generic or brand/generic) will cause a pharmacist to make a dispensing error?

₁ Very likely

₂ Somewhat likely

₃ Not very likely

A10. How likely is it that SIMILARITIES in appearance among different manufacturers’ versions of the same pill (generic/generic or brand/generic) will cause a pharmacist to make a dispensing error?

₁ Very likely

₂ Somewhat likely

₃ Not very likely

A11. How commonly do the following changes in pill appearance lead patients to express concern to you about increased side effects or reduced effectiveness?

	Almost always	Commonly	Occasionally	Rarely	Never
a. Color	1	2	3	4	5
b. Shape	1	2	3	4	5
c. Size	1	2	3	4	5
d. Markings (text, lines, grooves, or designs)	1	2	3	4	5

A12. Considering instances when you refill a prescription with a pill that differs in appearance from the prior prescription without having changed the drug or dose, please indicate how often you do each of the following.

	Almost always	Commonly	Occasionally	Rarely	Never
a. Notify the patient verbally, in person or on the phone	1	2	3	4	5
b. Notify the patient using a sticker on a prescription bottle	1	2	3	4	5
c. Log an incident report with the pharmacy when a patient complains about a change in pill appearance	1	2	3	4	5

A13. Please indicate how often the following occur when a patient is dispensed a medication that differs in appearance from the prior prescription without having changed the drug or dose.

	Almost always	Commonly	Occasionally	Rarely	Never
a. Changes in pill appearance lead patients to report side effects to me	1	2	3	4	5
b. Changes in pill appearance lead patients to report to me that their pill doesn’t work	1	2	3	4	5
c. Patients tell me that their pills should maintain consistency in appearance	1	2	3	4	5
d. Changes in pill appearance lead to gaps in adherence in the patients I service	1	2	3	4	5
e. Changes in pill appearance lead patients to discontinue their medications entirely	1	2	3	4	5
f. Changes in pill appearance lead patients to refuse to take home the medication (or try to return it to the pharmacy after taking it home)	1	2	3	4	5
g. Changes in pill appearance lead patients to express to me that they received the wrong medication	1	2	3	4	5
h. Changes in pill appearance lead patients to express confusion about the new medication’s appearance	1	2	3	4	5

^{section B: narrow therapeutic index (NTI) PILL APPEARANCE}

Patients may respond differently to changes in appearance among different categories of pills. This section focuses on “narrow therapeutic index” (NTI) pills. As you know, NTI pills are those for which small differences in dose or blood concentration may lead to therapeutic failures or adverse drug reactions. Classic examples include anticoagulants like warfarin, anti-epileptics like phenytoin, and immunosuppressants like tacrolimus.

B1. Do you think generic NTI pills are…?

₁ Definitely as effective as their brand-name versions

₂ Probably as effective as their brand-name versions

₃ Probably not as effective as their brand-name versions

₄ Definitely not as effective as their brand-name versions

₈ Don’t know/Not sure

B2. Do you think generic NTI pills are…?

₁ Definitely as safe as their brand-name versions

₂ Probably as safe as their brand-name versions

₃ Probably not as safe as their brand-name versions

₄ Definitely not as safe as their brand-name versions

₈ Don’t know/Not sure

B3. When you receive a prescription for a brand-name NTI pill and the prescription permits substitution, and the patient does not request brand-only, how often do you fill the prescription with a generic pill?

₁ Almost always (greater than 90% of the time)

₂ Commonly (51-90% of the time)

₃ Occasionally (10-50% of the time)

₄ Rarely (less than 10% of the time)

₅ Never

B4. When you substitute a generic NTI pill for a brand-name NTI pill prescription, how often do you directly inform the patient about the substitution?

₁ Almost always (greater than 90% of the time)

₂ Commonly (51-90% of the time)

₃ Occasionally (10-50% of the time)

₄ Rarely (less than 10% of the time)

₅ Never

Recall that pill appearance refers to the pill’s color, shape, size, or markings (such as text, lines, grooves, or designs).

B5. When patients receive a refill of NTI pills that differ in appearance from their prior prescription, do you think pharmacists should be…?

₁ Much more concerned about patient confusion than when patients receive a refill of non-NTI pills differing in

appearance from a prior prescription

₂ Somewhat more concerned about patient confusion than when patients receive a refill of non-NTI pills differing in appearance from a prior prescription

₃ Neither more nor less concerned about patient confusion than when patients receive a refill of non-NTI pills differing in appearance from a prior prescription

₄ Somewhat less concerned about patient confusion than when patients receive a refill of non-NTI pills differing in appearance from a prior prescription

₅ Much less concerned about patient confusion than when patients receive a refill of non-NTI pills differing in

appearance from a prior prescription

B6. Changes in appearance of NTI pills…

₁ Definitely lead patients to report to me side effects more often than changes in appearance of non-NTI pills

₂ Probably lead patients to report to me side effects more often than changes in appearance of non-NTI pills

₃ Probably do not lead patients to report to me side effects more often than changes in non-NTI pills’ appearance

₄ Definitely do not lead patients to report to me side effects more often than changes in non-NTI pills’ appearance

₈ Don’t know/Not sure

B7. Changes in appearance of NTI pills…

₁ Definitely lead patients to tell me that their pill does not work more often than for non-NTI pills

₂ Probably lead patients to tell me that their pill does not work more often than for non-NTI pills

₃ Probably do not lead patients to tell me that their pill does not work more often than for non-NTI pills

₄ Definitely do not lead patients to tell me that their pill does not work more often than for non-NTI pills

₈ Don’t know/Not sure

B8. Changes in appearance of NTI pills…

₁ Definitely lead patients to return or not take home their pills more often than for non-NTI pills

₂ Probably lead patients to return or not take home their pills more often than for non-NTI pills

₃ Probably do not lead patients to return or not take home their pills more often than for non-NTI pills

₄ Definitely do not lead patients to return or not take home their pills more often than for non-NTI pills

₈ Don’t know/Not sure

B9. Changes in appearance of NTI pills…

₁ Definitely lead to gaps in adherence more often than for non-NTI pills

₂ Probably lead to gaps in adherence more often than for non-NTI pills

₃ Probably do not lead to gaps in adherence more often than for non-NTI pills

₄ Definitely do not lead to gaps in adherence more often than for non-NTI pills

₈ Don’t know/Not sure

^{section C: background information}

C1. Please enter the 5-digit U.S. zip code for the primary location in which you practice. If you are in practice in more than 1 zip code, include the zip code where you spend most of your time.



C2. Are you…?

₁ Male

₂ Female

C3. Please indicate your race/ethnicity. Please check all that apply.

₁ White

₂ Black/African American

₃ Asian or Other Pacific Islander

₄ American Indian or Alaskan Native

₅ Latino

₆ Other (specify)

C4. Please describe the pharmacy in which you practice.

₁ Independent (4 or fewer stores)

₂ Regional Chain (approximately between 4 and 250 stores)

₃ National Chain

C5. Please describe the type of pharmacy in which you practice

₁ Stand-alone

₂ Supermarket-based

₃ Pharmacy chain

₄ Large store-based

C6. How many years have you been in practice? If less than a year, please enter “0.”

 years

C7. About how many prescriptions are filled per day in the pharmacy in which you work? If you work at multiple stores, please think about the one in which you spend the most time.

₁ Fewer than 100

₂ 100-200

₃ 201-300

₄ More than 300

C8. From what source(s) do you learn about a drug’s safety and effectiveness? Please select all that apply.

₁ Continuing education requirements

₂ Visit from a pharmaceutical representative

₃ Literature from a payor formulary committee

₄ Pharmacy or professional journals

₅ Package inserts

₆ Text or reference books

₇ Physicians

₈ Pharmacist colleagues

₉ Patients

₉₆ Other (specify)_______________________

C9. Please provide any additional comments about your views about or experiences with changes in pill appearance.

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY. PLEASE RETURN IT IN THE ENCLOSED ENVELOPE

OR MAIL IT TO THE ADDRESS NOTED ON THE BOOKLET COVER.

7