FDA REMS Practice Setting Overview – Screener for Focus Group Participants
Location: TBD
Date(s): TBD
Times: TBD
Special Instructions:
Recruit 12 for 9 to show
Mix of genders ok (50/50 good, but 60/40 either way ok)
Mix of ages and experience preferred
Mix of roles within prescriber practice/processes
Looking for in depth knowledge and experience in (specific) prescriber setting
Screener
Participant Screener for Practitioner Focus Groups
Hello, my name is __________________ and I'm calling about a prescriber setting research study sponsored by the Food and Drug Administration. As part of this study, we are recruiting participants for upcoming focus group sessions. Participants in these focus groups will be asked to share their experiences with prescription practices within a specific provider setting. This is an opportunity to share your experience, promote a common understanding of your work environment and its challenges, and potentially contribute to policies aimed at its improvement. All of the information provided will remain private to the extent permitted by law. Would you mind answering a few questions?
Q1. Please describe the practice setting in which you work (see examples below)
Specialty:
Practice group/organization (e.g., multispecialty, academic, etc.):
Size (# of physicians w/in practice):
Types of prescribers (MDs, DOs, NPs, PAs):
Typical patient population (e.g., indigent, rural):
Physical facility (multiple offices, hospital/clinic):
Q2. Please describe the capacity in which you work
Current title:
Current role within practice:
Specific expertise/practice focus:
Specific populations served:
Q3. How long have you worked in this capacity? In this setting?
Q4. In what other settings do you have experience?
Document response: _________________________________
Q5. In what other specialties do you have experience?
Document response: _________________________________
Q6. Are you familiar with / have you ever heard of Risk Evaluation and Mitigation Strategies (REMS) and/or Elements to Assure Safe Use (ETASUs) for x disease [disease state TBD]?
Document response: _________________________________
Q7. Do you participate in the prescription process?
Yes continue, Go to Q8
No Go to Q9
Q8. What is your role(s) in the prescription process?
Document response: _________________________________
Q9: Do you or have you or anyone from your immediate family worked in or retired from any of the following:
Market Research Firm eliminate
The Food and Drug Administration eliminate
The National Institutes of Health eliminate
Pharmaceutical Company eliminate
The Department of Health and Human Services eliminate
A State Health Department eliminate
Q10. Have you participated in a focus group within the past six months?
[Interviewer: participation in telephone surveys is allowable]
Yes eliminate [thank respondent politely]
Q11. Gender
Male
Female
Q12. How old are you? (if under 21 or over 61, eliminate)
Under 21
21 – 30 years old (include)
31 – 40 years old (include)
41 – 50 years old (include)
51 – 60 years old (include)
61 or older
Q13. What is the highest level of education that you have completed?
Less than high school
High school graduate or GED
Technical/vocational school
Some college credit but no degree
Associate’s degree (AA, AS)
Bachelor’s degree (BA, AB, BS)
Advanced degree (MA, MS, MEd, MEng, MBA, MSW, PhD, MD, JD, DVM, EdD)
Q14. Are you of Hispanic, Latino, or Spanish origin?
Yes
No
Q15. What is your race? Please select one or more.
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
We would like to invite you to participate in a focus group to discuss the prescription practices within your provider setting with 8 or so other participants. The focus group will take place on (Day), (Date), at [6:00 or 8:00 p.m.] at [site location]. The discussion will last approximately 90 minutes and will include both men and women. The group will be audio recorded and observed by staff from the FDA. However, your participation and everything you say during the discussion will be kept private and confidential to the extent permitted by law. The FDA will not have your full names and will keep all tapes locked up until they are destroyed.
Additionally, light refreshments such as [insert type of food served] before the group discussion will start.
Will you be available to participate at this time?
Yes continue
No [Thank the person for his/her time]
I would like to send you a confirmation letter and directions to the focus group facility. Can you please tell me your mailing address (or fax number) and a phone number where you can be reached:
Name: ______________________________________
Address: __________________________________________________________
City: _______________________ State: _________ Zip: ______________
Phone: _______________________
Email: _______________________
Date of focus group: __________________ Time: ________________
We are only inviting a few people, so it is very important that you notify us as soon as possible if for some reason you are unable to attend. Please call [recruiter] at [telephone number] if this should happen.
We look forward to seeing you on [date] at [time]. If you use reading glasses, please bring them with you to the session.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Koeppl, Patrick |
File Modified | 0000-00-00 |
File Created | 2021-02-01 |