Tab 2
PRIMARY CARE PROVIDER SURVEY
As part of the Stay Connected project, all primary care providers at this clinic are being asked to complete a very brief survey periodically. Your participation on this survey is voluntary. Your consent to participate is implied by completing and returning this survey.
Your name will not appear on this survey but we will ask you to provide the last two digits of your social security number and the month you were born as a means of linking your surveys across time.
If you decide to participate, please seal your completed survey in the attached envelope and return to the study coordinator (name of person).
Last two digits of your social security number: _____ _____
Month of your birth (check one):
January July
February August
March September
April October
May November
June December
1. Today’s Date: ___ ___/___ ___/___ ___ ___ ___ (MM/DD/YYYY)
2. Study Site
Alabama-Birmingham Johns Hopkins
Boston Miami
Houston/Thomas St. SUNY Brooklyn
3. What type of medical provider are you?
MD/DO
PA
NP
4. What is your sex?
Female
Male
5. Think back to the last clinic session in which you saw patients for HIV primary medical care. How many of these patients did you talk to about the importance of keeping clinic appointments?
Every patient (100%)
Almost every patient (80- 99%)
More than half of the patients (60-79%)
About half of the patients (40-59%)
Fewer than half of the patients (20-39%)
Very few patients (1-19%)
No patients (0%)
6. Think back to the last clinic session in which you saw patients for HIV primary medical care. With how many of these patients did you point out the exam room poster showing that regular clinic attendance can improve CD4 and viral load?
Every patient (100%)
Almost every patient (80- 99%)
More than half of the patients (60-79%)
About half of the patients (40-59%)
Fewer than half of the patients (20-39%)
Very few patients (1-19%)
No patients (0%)
7. Compared to before the Stay Connected project started, how much are you talking to patients about the importance of keeping clinic appointments?
Much less than before
Somewhat less than before
About the same as before
Somewhat more than before
Much more than before
8. Compared to before the Stay Connected project started, how much attention is the clinic giving to the importance of patients keeping clinic appointments?
Much less than before
Somewhat less than before
About the same as before
Somewhat more than before
Much more than before
| File Type | application/msword |
| File Title | TAB 1 |
| Author | Faye Malitz |
| Last Modified By | HRSA |
| File Modified | 2009-07-16 |
| File Created | 2009-06-30 |