Form #3 Clinician and Policymaker Summary Guides from health car

Eisenberg Center Voluntary Customer Survey Generic Clearance for the AHRQ

Attachment B3 -- Oral meds for Type 2 diabetes clinician guide _ feedback survey for health care providers

Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program

OMB: 0935-0128

Document [doc]
Download: doc | pdf

Form Approved
OMB No. 0935-0128
Exp. Date XX/XX/20XX

Thank you for taking the time to tell us what you think about the Comparing Oral Medications for Adults with Type 2 Diabetes clinician summary guide. The information you provide will help us to improve current and future guides. You may choose not to answer any question, and your responses are completely anonymous. No information that could be used to identify you will be collected. The average time required to complete this survey is 5 minutes.

0. Please choose ONE statement that best describes you:

 X

I am a health care professional who provides care to people with Type 2 diabetes


 

I am a health care administrator or policymaker


 

I have Type 2 diabetes


 

I am the caregiver, family member or friend of someone with Type 2 diabetes


 

Other ---> Please describe yourself


1. How useful to you was the clinical bottom line section?

 

Very useful


 

Somewhat useful


 

Not very useful ---> Why not?


2. How useful to you was the confidence scale?

 

Very useful


 

Somewhat useful


 

Not very useful ---> Why not?


3. How useful was the cost information?

 

Very useful


 

Somewhat useful


 

Not very useful ---> Why not?


4. Did you learn anything new from the guide?

 

Yes, a lot


 

Yes, some


 

No




Public reporting burden for this collection of information is estimated to average 5 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0128) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.







5. What was your level of knowledge on this topic before reading the guide?

 

Limited


 

Fair


 

Good


 

Very Good


 

Expert


6. Did you disagree with any of the information in the guide?

 

No


 

Yes ---> Please describe


7. Will the information in this guide influence or change your treatment recommendations in the future?

 

Yes


 

Not sure ---> Why not?


 

No ---> Why not?


8. Would this guide help you to discuss treatment options with your patients?

 

Yes


 

Not sure ---> Why not?


 

No ---> Why not?


9. Would you recommend this clinician guide to others?

 

Yes, definitely


 

Not sure ---> Why not?


 

No ---> Why not?


10. Would you like to give us any other comments or thoughts about the guide?

 



11. How did you find this clinician guide?

 

Internet search


 

I received an e-mail notification from AHRQ's Effective Health Care Program


 

Link from another website ---> Which website?


 

Link from companion consumer's guide


 

Colleague


 

Professional organization email, newsletter, journal ---> Please describe


 

Other ---> Please describe


12. Have you seen the companion patient guide, Pills for Type 2 Diabetes: A Guide for Adults, which is available at the Effective Health Care website?

 

No


 

No, but I plan to look at it


 

Yes, I have looked at it


13. What type of health care professional are you?

 

Physician


 

Physician Assistant


 

Nurse Practitioner


 

Registered Nurse


 

Pharmacist


 

Social Worker


 

Health Educator


 

Dentist


 

Medical/nursing/dental/pharmacy student


 

Other ---> Please describe


14. Are you:

 

Male


 

Female


15. What is your age?

 

Under 30


 

30-44


 

45-59


 

60 or older




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File Modified2009-07-01
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