Physician/Nurse/Practitioner Provider Survey

Attachment 3

Medical Monitoring Project Provider Survey

OMB NO.:

EXPIRATION DATE:

Medical Monitoring Project (MMP):

Provider Survey

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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: CDC, Project Clearance Officer, 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (XXX-XXX). Do not send the completed form to this address.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

Atlanta, GA 30333

A. Medical Care Provider Characteristics

1. What is your profession?

Physician..................................................................... 1

I am completing a fellowship, residency, or internship. 2 → We are only eliciting responses from physicians who have completed their training, nurse practitioners, and physician assistants. Please stop here and return the survey using the self-addressed postage paid envelope. Thank you for your time.

Nurse Practitioner........................................................ 3

Physician Assistant...................................................... 4 → Skip to question 3

Other, please specify: ________________________. 5 → We are only eliciting responses from physicians, nurse practitioners, and physician assistants. Please stop here and return the survey using the self-addressed postage paid envelope. Thank you for your time.

2. Are you board certified in any of the following? Check all that apply.

Internal Medicine................................ 1

Family Practice................................... 2

Pediatrics............................................ 3

Surgery............................................... 4

Obstetrics and Gynecology................ 5

Neurology........................................... 6

Dermatology....................................... 7

Infectious Diseases............................ 8

Hematology-Oncology........................ 9

Immunology........................................ 10

American Center for Accreditation of Nurse Practitioners (ACANP)........... 11

Other board certification..................... 12 → Please specify:______________________________

3. What year did you graduate from professional school (i.e., medical,

nurse practitioner, or physician assistant school)?

4. What is your age in years?

5. Are you male or female?

Male.......... 1

Female..... 2

6a. Do you consider yourself to be Hispanic or Latino/a?

Yes.................. 1

No.................... 2 → Skip to question 7

6b. Which best describes your Hispanic ancestry? Check all that apply.

Mexican........... 1

Puerto Rican.... 2

Cuban.............. 3

Dominican....... 4

Other............... 5 → Please specify:______________________________

7. Which racial group or groups do you consider yourself to be in? You may choose more than one.

American Indian or Alaska Native............... 1

Asian.......................................................... 2

Black or African-American.......................... 3

Native Hawaiian or other Pacific Islander... 4

White.......................................................... 5

8. Do you communicate in another language besides English to provide medical care?

Yes.................. 1 → Please list other language(s): ____________________________________________

No.................... 2

9. How long have you been caring for patients living with HIV/AIDS?

Years Months

10. Do you consider yourself a specialist in the treatment of HIV/AIDS?

Yes.................. 1

No.................... 2

Don’t know....... 7

11. How knowledgeable do you consider yourself regarding HIV treatment?

Extremely knowledgeable..... 1

Very knowledgeable............. 2

Somewhat knowledgeable.... 3

Not at all knowledgeable...... 4

12. Please select all the sources of information on HIV care and treatment you usually use.

USPHS and/or IDSA antiretroviral guidelines........................................... 1

Other HIV care guidelines........................................................................ 2

International/National conferences........................................................... 3

National/Regional AIDS Education & Training Centers (AETC)............... 4

Medical journals/ Textbooks..................................................................... 5

Colleagues................................................................................................ 6

In-services (i.e. Grand Rounds)................................................................ 7

Internet sources (i.e. Clinical Care Options, The Body)............................ 8

Pharmaceutical Representatives/ Pharmaceutical sponsored meetings.. 9

Medical associations................................................................................ 10

The National HIV Telephone Consultation Service (Warmline)................ 11

Other, specify: ___________________________________________.... 12

B. Your Practice’s Characteristics

Please estimate the following:

13. During an average month, how many individual patients living with HIV/AIDS

do you provide care to?

Patients living with HIV/AIDS per month

14. During an average month, how many individual patients without HIV/AIDS

do you provide care to?

Non-HIV-infected patients per month

My patient load consists only of patients living with HIV/AIDS

15. Please make an educated guess on the percentage of your scheduled patients living with HIV/AIDS

who miss their appointments with you on an average clinic week?

% of patients living with HIV/AIDS

16. Please make an educated guess on the percentage of your scheduled non-HIV-infected patients

who miss their appointments with you on an average clinic week?

% of non-HIV-infected patients

My patient load consists only of patients living with HIV/AIDS

17. How often do you refer patients living with HIV/AIDS to another

physician with specialized knowledge for:

	Never	Less than half the time	Half the time	More than half the time	Always
	▼	▼	▼	▼	▼

a. Initial HIV evaluation?.................................. 1.............. 2................. 3................. 4............. 5

b. Initiating anti-retroviral therapy?.................. 1.............. 2................. 3................. 4............. 5

c. Evaluating possible changes in anti-retroviral therapy?........................... 1.............. 2................. 3................. 4............. 5

d. Interpretation of a viral load or other test result?..................................... 1.............. 2................. 3................. 4............. 5

e. Choosing an alternative opportunistic infection prophylactic treatment? ........... 1.............. 2................. 3................. 4............. 5

C. Characteristics of Your HIV-Infected Patients

The following questions pertain to your patients living with HIV/AIDS.

18. In an average month, approximately what percentage of your patients living with HIV/AIDS

fall into the following categories? The total should equal 100%.

a. American Indian or Alaska Native.................................….				%
b. Asian..............................….				%
c. Black or African American…				%
d. Hispanic or Latino................				%
e. Native Hawaiian or Other Pacific Islander…………………				%
f. White………………………….				%
Total...............................….	1	0	0	%

19. In an average month, approximately what percentage of your patients living with HIV/AIDS

fall into the following categories?

a. Women...............................				%
b. Transgender/Transsexual...				%
c. Injecting drug users............				%

20. What percentage of your male patients living with HIV/AIDS is men who have sex with other men?

%

D. Your Perspectives

21. For patients who are clinically eligible for antiretroviral therapy, what are the main

reasons that you might delay initiating antiretroviral therapy?

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

22. Please give your opinion of the following statements.

	Strongly Agree	Somewhat Agree	Neither Agree nor Disagree	Somewhat Disagree	Strongly Disagree
	▼	▼	▼	▼	▼

a. My patients living with HIV/AIDS seek HIV care only after experiencing symptoms.................... 1............. 2................ 3................. 4............. 5

b. In the community I serve, persons living with HIV/AIDS can obtain HIV care if needed................. 1............. 2................ 3................. 4............. 5

c. My patients living with HIV/AIDS understand the meaning of viral load and CD4 cell count........... 1............. 2................ 3................. 4............. 5

d. I only prescribe antiretrovirals if I believe a patient is likely to be adherent with the regimen...... 1............. 2................ 3................. 4............. 5

e. I have sufficient time to provide all the HIV care needed to my patients living with HIV/AIDS............. 1............. 2................ 3................. 4............. 5

23. Do you provide care to any patients living with HIV/AIDS who

receive ADAP (AIDS Drug Assistance Program)?

Yes.................. 1

No.................... 2 → Skip to question 24

Don’t know....... 7 → Skip to question 24

23a. Please give your opinion of the following statement:

The amount of HIV related medications ADAP allows my patients

to receive meets their HIV treatment needs.

Strongly Agree...................... 1

Somewhat Agree.................. 2

Neither Agree nor Disagree.. 3

Somewhat Disagree.............. 4

Strongly Disagree................. 5

24. Do you provide care to any patients living with HIV/AIDS who are

enrolled in the Medicare Prescription Drug Benefit plan?

Yes.................. 1

No.................... 2 → Skip to question 25

Don’t know....... 7 → Skip to question 25

24a. Please give your opinion of the following statement:

The Medicare Prescription Drug Benefit plan has made it easier for

my HIV infected patients to get their HIV medications.

Strongly Agree...................... 1

Somewhat Agree.................. 2

Neither Agree nor Disagree.. 3

Somewhat Disagree.............. 4

Strongly Disagree................. 5

25. CDC recently recommended HIV screening in health care settings for all patients 13 to 64 years of age.

Do you offer HIV screening to your patients? (Please select one answer below that comes closest to your situation.)

Yes, to all my patients 13 to 64 years of age..................................................................... 1

Yes, but mainly to patients who engage in high-risk behaviors......................................... 2

No, but I plan to start offering HIV screening for all my patients 13 to 64 years of age..... 3

No, I do not think HIV screening is necessary for all my patients 13 to 64 years of age.... 4

Not Applicable, as I only see patients living with HIV/AIDS............................................... 5

E. HIV Care Related Services and Barriers to Care

26. Please indicate whether you discuss each of the following topics with your patients living with HIV/AIDS who are new to HIV care. A patient new to HIV care is someone who has not previously obtained HIV care, not a patient new to your practice.

	Always Discuss	Frequently Discuss	Sometimes Discuss	Almost Never Discuss	Never Discuss
Medical Related Issues for Patients Prescribed HIV Medications	▼	▼	▼	▼	▼

a. Adherence with antiretroviral regimen................ 1............. 2................ 3................. 4................. 5

b. Adherence with OI prophylaxis........................... 1............. 2................ 3................. 4................. 5

c. How to take medicines....................................... 1............. 2................ 3................. 4................. 5

d. Medical related side effects................................ 1............. 2................ 3................. 4................. 5

e. Drug-Drug interactions....................................... 1............. 2................ 3................. 4................. 5

f. Pregnancy or potential pregnancy with female patients................................................. 1............. 2................ 3................. 4................. 5

HIV and STD Prevention Issues

g. Risk reduction regarding HIV transmission........ 1............. 2................ 3................. 4................. 5

h. Condom use....................................................... 1............. 2................ 3................. 4................. 5

i. Availability of partner counseling services........... 1............. 2................ 3................. 4................. 5

j. Disclosure of HIV status to their partners............ 1............. 2................ 3................. 4................. 5

k. Substance abuse................................................ 1............. 2................ 3................. 4................. 5

Other HIV Care Related Issues

l. Sexually transmitted disease............................... 1............. 2................ 3................. 4................. 5

m. Need for hepatitis screening.............................. 1............. 2................ 3................. 4................. 5

n. Need for tuberculosis screening......................... 1............. 2................ 3................. 4................. 5

o. Hepatitis (A and B) vaccination.......................... 1............. 2................ 3................. 4................. 5

p. Tuberculosis disease risk................................... 1............. 2................ 3................. 4................. 5

q. Wellness (nutrition, exercise, etc.)..................... 1............. 2................ 3................. 4................. 5

r. Pregnancy or potential pregnancy with female patients not on ART.............................. 1............. 2................ 3................. 4................. 5

Psychosocial Related Issues

s. Family/social support.......................................... 1............. 2................ 3................. 4................. 5

t. Mental health problems, including depression.... 1............. 2................ 3................. 4................. 5

u. Other, specify:_________________________.. 1............. 2................ 3................. 4................. 5

26a. On average, how many minutes are you able to spend with a patient living with HIV/AIDS who is new to HIV care?

minutes

26b. In your opinion, do you have sufficient time to provide all HIV related information

needed to your patients living with HIV/AIDS who are new to HIV care?

Yes.................. 1

No................... 2

Don’t know...... 7

27. Please indicate whether you discuss each of the following topics at each return appointment with your established patients living with HIV/AIDS. Established patients are those who have been seen at your facility/practice on at least one prior occasion for HIV care.

	Always Discuss	Frequently Discuss	Sometimes Discuss	Almost Never Discuss	Never Discuss
Medical Related Issues for Patients Prescribed HIV Medications	▼	▼	▼	▼	▼

a. Adherence with antiretroviral regimen................ 1............. 2................ 3................. 4................. 5

b. Adherence with OI prophylaxis........................... 1............. 2................ 3................. 4................. 5

c. How to take medicines....................................... 1............. 2................ 3................. 4................. 5

d. Medical related side effects................................ 1............. 2................ 3................. 4................. 5

e. Drug-Drug interactions....................................... 1............. 2................ 3................. 4................. 5

f. Pregnancy or potential pregnancy with female patients................................................. 1............. 2................ 3................. 4................. 5

HIV and STD Prevention Issues

g. Risk reduction regarding HIV transmission........ 1............. 2................ 3................. 4................. 5

h. Condom use....................................................... 1............. 2................ 3................. 4................. 5

i. Availability of partner counseling services........... 1............. 2................ 3................. 4................. 5

j. Disclosure of HIV status to their partners............ 1............. 2................ 3................. 4................. 5

k. Substance abuse................................................ 1............. 2................ 3................. 4................. 5

Other HIV Care Related Issues

l. Sexually transmitted disease............................... 1............. 2................ 3................. 4................. 5

m. Need for hepatitis screening.............................. 1............. 2................ 3................. 4................. 5

n. Need for tuberculosis screening......................... 1............. 2................ 3................. 4................. 5

o. Hepatitis (A and B) vaccination.......................... 1............. 2................ 3................. 4................. 5

p. Tuberculosis disease risk................................... 1............. 2................ 3................. 4................. 5

q. Wellness (nutrition, exercise, etc.)..................... 1............. 2................ 3................. 4................. 5

r. Pregnancy or potential pregnancy with female patients not on ART.............................. 1............. 2................ 3................. 4................. 5

Psychosocial Related Issues

s. Family/social support.......................................... 1............. 2................ 3................. 4................. 5

t. Mental health problems, including depression.... 1............. 2................ 3................. 4................. 5

u. Other, specify:_________________________.. 1............. 2................ 3................. 4................. 5

27a. On average, how many minutes are you able to spend with an established patient living with HIV/AIDS?

minutes

27b. In your opinion, do you have sufficient time to provide all HIV related information

needed to your established patients living with HIV/AIDS?

Yes.................. 1

No................... 2

Don’t know...... 7

28. Thinking about your patients living with HIV/AIDS, please indicate the importance of the following barriers they may experience in obtaining HIV care at your facility/clinic.

	Not Important	Slightly Important	Moderately Important	Very Important
Structure Level Barriers	▼	▼	▼	▼

a. Lack of childcare at facility/clinic......................... 1................ 2................ 3................. 4

b. Inconvenient facility/clinic hours......................... 1................ 2................ 3................. 4

c. Inconvenient facility/clinic location...................... 1................ 2................ 3................. 4

d. Lack of translation services................................ 1................ 2................ 3................. 4

e. Cost of HIV care................................................. 1................ 2................ 3................. 4

f. No insurance coverage....................................... 1................ 2................ 3................. 4

g. Length of time to schedule appointments........... 1................ 2................ 3................. 4

h. Transportation problems.................................... 1................ 2................ 3................. 4

Individual Level Barriers

i. Culturally based health beliefs and behaviors of patients......................................... 1................ 2................ 3................. 4

j. Inability of patients to understand medical instructions.......................................... 1................ 2................ 3................. 4

k. Lack of social support systems........................... 1................ 2................ 3................. 4

l. Mental health problems....................................... 1................ 2................ 3................. 4

m. Drug abuse problems........................................ 1................ 2................ 3................. 4

n. Alcohol abuse problems..................................... 1................ 2................ 3................. 4

Thank you for your participation!

For more information on MMP, please go to: http://www.cdc.gov/hiv/projects/mmp/default.htm