2 Pretest

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APPENDIX A-1
HIV Clinician Workforce Study
Clinician Survey
Draft Questionnaire
PRETEST VERSION
June 27, 2011

Submitted to:
The HIV/AIDS Bureau
Health Resources and Services Administration
by
Mathematica Policy Research
and
The Lewin Group

Public Statement

INTRODUCTION
The purpose of this survey. The HIV/AIDS Bureau (HAB) within the U.S. Department of Health and Human Services’
Health Resources and Services Administration (HRSA) is conducting a national study to better understand the size and
characteristics of the health profession workforce currently providing medical care to people living with HIV or AIDS in the
United States. HRSA will use the information to assess the capacity of HIV clinicians to meet the health care needs of the
population living with HIV/AIDS and to develop strategies to address potential workforce shortages in the future.
Why your participation is critical. You were selected to participate in this survey because— through an initial review of
medical and pharmacy claims data— you were identified as one of a small number of clinicians who provide direct care to
a significant number of patients living with and treated for HIV or AIDS. HRSA needs the information that only you can
provide in this survey to better understand the size, characteristics, and distribution of the HIV clinician workforce and their
implications for the supply of HIV clinicians in the future.
Thank you for helping. To thank you for helping HRSA to address these important questions about the capacity of the
HIV clinician workforce in the United States, we will send you a gift card for $40.00 once you have completed and
returned the questionnaire.
Questionnaire Sections
Page
Eligibility Screener ........................................................................................................................................................... 1
A.

Background ............................................................................................................................................................. 2

B.

Hours Spent in Patient Care.................................................................................................................................... 3

C.

Patient Load ............................................................................................................................................................ 4

D.

Practice Environment .............................................................................................................................................. 6

E.

Practice Management ............................................................................................................................................. 8

F.

Future Plans .......................................................................................................................................................... 10

G.

Perception about HIV Clinician Capacity .............................................................................................................. 12

H.

Demographic Characteristics ................................................................................................................................ 14

I.

Contact Information ............................................................................................................................................... 15

Completing the survey. You may complete the survey at your convenience in one of three ways: (1) by filling out this
paper version and returning it to us in the enclosed pre-paid envelope; (2) by completing a web-based questionnaire using
the URL and password provided in the cover letter; or (3) by participating in a telephone interview with one of our
interview specialists. If you chose to use the web-based instrument, the system will automatically prompt you to the next
question, which expedites the completion process. Your best estimate on questions that ask for quantitative responses is
fine. The survey should take no more than 15 minutes to complete.
Instructions when using the paper survey:
• If there is no “Go To” instruction, proceed to the next question.
• If there is a “Go To” instruction, go to the question indicated.
• There are notes to guide you in your responses. They appear in italics.

ii

ELIGIBILITY SCREENER

S1.

Are you currently providing direct medical care in the United States to patients diagnosed with HIV
or AIDS?
1

0

S2.

2

3

4

□

No

GO TO S4

□

Allopathic (MD) or Osteopathic Physician (DO)

□

Nurse Practitioner (NP)

GO TO Q1

□

Physician Assistant (PA)

GO TO Q1

□

Other health profession

GO TO S4

GO TO S3

What is your primary medical specialty? (Mark only one.)
1

2

3

4

5

6

S4.

Yes

What is your primary health profession? (Mark only one.)
1

S3.

□

□

Internal Medicine

□

Family/General Medicine

□

Infectious Disease

□

Pediatrics

□

Geriatrics

□

Other medical specialty (Please specify)

GO TO Q1

_________________________________

Because you are not currently providing medical care to patients with HIV/AIDS in the United
States or your medical profession or medical specialty is outside the scope of the study, you are
ineligible to participate in this survey. However, we still need to hear this from you! Please put this
paper questionnaire in the pre-paid envelope we provided and mail it back to us so we will know to
remove you from our respondent follow-up list. Thank you for your help.

[Type text]

A. BACKGROUND

1.

In approximately what year did you receive your highest health care profession degree?
|___|___|___|___| YEAR

2.

In what country did you receive your highest health profession degree?
1

2

3.

□

United States

□

International (Please specify country)

________________________________

In approximately what year did you begin providing direct medical care to patients with HIV or
AIDS?
|___|___|___|___| YEAR

4.

What factors had the greatest influence on your decision to pursue a career providing medical care
to patients with HIV or AIDS? (Mark all that apply.)
1

2

3

4

5

6

7

8

□

Joined a practice that included patients with HIV or AIDS

□

Increase in the number of patients with HIV or AIDS in my existing practice

□

Personal interest in providing care to people living with HIV or AIDS

□

Personal interest in HIV and/or other infectious diseases

□

Prior experience working with people living with HIV or AIDS

□

Studied HIV care (residency, preceptorship, or other special training program)

□

Opportunity to serve an underserved group

□

Earnings potential/ financial advantages

[Type text]

B. HOURS SPENT IN PATIENT CARE

5.

In a typical week, in all your practice locations, approximately how many hours do you spend in
total patient care? (Please count time related to patient care that might not be spent with patients,
such as chart review, clinical documentation, lab test ordering or reviewing, making referrals, and
traveling between clinics.)
|___|___|___| HOURS

6.

In a typical week, in all your practice locations, approximately how many hours of your total
direct patient care time is spent treating patients with HIV or AIDS? (Hours reported in Q.6 must
be equal to or less than hours reported in Q.5.)
|___|___|___| HOURS

7.

In a typical week, in all your practice locations, approximately how many hours do you spend
engaged in each of the following direct care activities for patients with HIV or AIDS? (Hours must
add up to time spent treating patients with HIV or AIDS in Q.6. If no hours to report for a given
activity, please record as zero.)
Hours

1

2

3

4

5

6

7

8

9

□

Conducting intake and clinical assessment of new patients

|___|___|

□

Reviewing patient charts or examining established patients

|___|___|

□

Clinical documentation

|___|___|

□

Monitoring, managing, or prescribing medications

|___|___|

□

Reviewing or ordering laboratory, radiology, or other diagnostic tests

|___|___|

□

Counseling or educating patients and their families

|___|___|

□

Making and tracking referrals for specialty care

|___|___|

□

Traveling between clinics

|___|___|

□

Other (Please specify) _____________________________________

|___|___|

Total hours in direct patient care (Must equal hours reported in Q.6)

|___|___|

10

□

[Type text]

C. PATIENT LOAD
When answering questions in Section C, please include patients in all your practice locations.

8.

Approximately how many total patients do you currently treat on an ongoing basis? (Please count
patients with and without HIV.)
|___|___|___| PATIENTS

9.

Of your total patient load, how many patients fall within each of the following categories? (The total
count must add up to the number of patients reported in Q.8.)
|___|___|___| PATIENTS WITHOUT HIV/AIDS DIAGNOSIS
|___|___|___| PATIENTS WITH HIV DIAGNOSIS, BUT NOT AIDS
|___|___|___| PATIENTS WITH AIDS DIAGNOSIS
|___|___|___| PATIENTS WITH AN UNKNOWN HIV STATUS
|___|___|___| TOTAL PATIENTS (Must equal number reported in Q8)

10.

About what percentage of your current HIV patient load is in each of the following patient
categories? (If no patients to report in a given category, please record as zero. The total
percentage must add up to 100 percent. )
Percentage
of HIV Patients
1

2

3

□

Diagnosed with HIV/AIDS in past 12 months ....................................... |___|___|___|

□

New to your practice but not newly diagnosed ..................................... |___|___|___|

□

Established in care at your practice ...................................................... |___|___|___|

TOTAL

11.

100 %

About what percentage of your current HIV patient load is in each of the following antiretroviral
therapy categories? (If none in given category, please record as zero. The total percentage must
add up to 100 percent.)
Percentage
of HIV Patients
1

2

3

4

□

No antiretroviral therapy ......................................................................... |___|___|___|

□

HAART.................................................................................................... |___|___|___|

□

Other (mono or dual therapy) ................................................................. |___|___|___|

□

Unknown ................................................................................................. |___|___|___|

TOTAL .............................................................................................................

[Type text]

100%

12.

Approximately what percent of your current HIV patient load also has the following conditions? (If
none to report in a given category, please record as zero. The total percentage does not need to
add up to 100 percent.)
Percent
of HIV Patients
1

2

3

4

13.

□

Serious mental illness ............................................................................. |___|___|___|

□

A substance abuse disorder ................................................................... |___|___|___|

□

Hepatitis B or C ...................................................................................... |___|___|___|

□

Other significant comorbidity .................................................................. |___|___|___|

In a typical week, about how many total patient visits do you conduct?
|___|___|___| VISITS

14.

In a typical week, about how many of your total patient visits are for patients with HIV or AIDS?
|___|___|___| VISITS

15.

In the past year, has your HIV patient load increased, decreased, or stay about the same? (Please
include visits for patients with HIV or AIDS in all your practice locations.)

□
2□
3□
1

Increased
Decreased

GO TO Q.16

Stayed the same

GO TO Q.16

15a. Approximately how much has your HIV patient load has increased in the past year? (Please mark
only one.)

□
2□
3□
4□
1

Increased by less than 10%
Increased by more than 10% but less than 20%
Increased by more than 20% but less than 30%
Increased by 30% or more

[Type text]

D. PATIENT ENVIRONMENT

16. Please mark all the practice settings in which you provide direct medical care to patients with HIV or
AIDS. (Mark all that apply.)
1

□

Private clinic or office

□

Hospital or university-based outpatient clinic

3

□

Hospital inpatient department

4

□

Emergency Department

5

□

Publicly funded health center or clinic

6

□

Other community-based health center

7

□

AIDS service organization

8

□

Public health department clinic

9

□

Other (Please specify)__________________________________

17.

Please mark the one practice setting where you spend most of your time providing direct medical
care to patients with HIV or AIDS. (Mark one only.)
1

□

Private clinic or office

 GO TO Q.17a

2

□

Hospital or university-based outpatient clinic

 GO TO Q.17b

3

□

Hospital inpatient department

 GO TO Q.17b

4

□

Emergency department

5

□

Publicly funded health center or clinic

 GO TO Q.18

6

□

Other community-based health center

 GO TO Q.18

7

□

AIDS service organization

 GO TO Q.18

8

□

Public health department clinic

 GO TO Q.18

9

□

Other (Please specify) ________________________________

GO TO Q.17b

17a. Is your private clinic or office a…? (Mark only one.)
1

□ Solo practice

2

□ Group practice, single-specialty

3

□ Group practice, multi-specialty

GO TO Q.18

17b. Is the hospital operated by…? (Mark only one.)
1

□ A federal, state, county, or city government

2

□ A private nonprofit organization

3

□ A private for-profit organization

[Type text]

18.

Does your primary practice receive Ryan White HIV/AIDS Program funding?

□
0□
d□
1

19.

Yes
No
Don’t know

Is your primary practice part of an integrated health care system composed of multiple provider
organizations that share resources and offer a comprehensive continuum of care?

□
0□
d□
1

Yes
No
Don’t know

GO TO Q20

19a. Does this integrated health care system include any of the following? (Mark all that apply.)

□
2□
3□
4□
5□
1

HIV/AIDS specialty ambulatory care clinic
Multi-specialty ambulatory clinic(s)
Hospital inpatient department(s)
Substance abuse and/or mental health counseling and treatment centers
Clinical pharmacy

[Type text]

E. PRACTICE MANAGEMENT

20.

Does your primary practice use a computerized or electronic medical record (EMR) system?

□
0□
d□
1

Yes
No
Don’t know

GO TO Q21

20a. Does your primary practice use the EMR system for any of the following? (Mark all that apply.)
1

2

3

4

5

6

7

8

9

10

11

21.

□

To review patient records

□

To increase adherence to clinical guidelines

□

To share clinical information with providers internal to your practice

□

To share clinical information with providers external to your practice

□

To share clinical information with patients

□

To write and order prescriptions (also called e-prescribing)

□

To order laboratory, radiology, or other diagnostic tests

□

To receive laboratory, radiology, or other diagnostic test results

□

To make referrals for specialty care

□

To track patient enrollment, appointments, and/or referrals?

□

To monitor quality of care?

Has your primary practice implemented any appointment scheduling procedures or policies
intended to increase the number of patients you can see or expedite the flow of patients through
your clinic?

□
0□
d□
1

Yes
No

GO TO Q.22

Don’t know

21a. Do these scheduling procedures or policies include any of the following? (Mark all that apply.)

□ Expediting intake and eligibility and medical screening appointments
2 □ Contacting patients to remind them of their appointments
3 □ Double-booking appointments
4 □ Maintaining open appointments for walk-ins
1

[Type text]

□ Maintaining cancellation lists
6 □ Offering group appointments
7 □ Providing medical case managers to help patients navigate health care system
8 □ Providing peer counselors to help patients understand and adhere to treatment
9 □ Coordinating appointments so that patients see multiple clinicians during one visit
5

22.

At your primary practice, do you share clinical management of your HIV patients with non-HIV
physicians or other clinicians, some of whom may be outside your primary practice?

□
0□
d□
1

23.

□
0□
d□

Don’t know

Yes
No
Don’t know

At your primary practice, do you offer services specifically designed to promote the long-term self
management of HIV disease, including medication therapy management, patient education, and
peer counseling?

□
0□
d□
1

25.

No

At your primary practice, do you delegate HIV-related clinical tasks and responsibilities to staff
with less training, such as from physicians to nurse practitioners or from nurse practitioners to
registered nurses?
1

24.

Yes

Yes
No
Don’t know

At your primary practice, do you use an integrated team approach where multiple clinicians (such
as physicians, nurses, and medical assistants) work together to augment and enhance the
physician visit by providing previsit, postvisit, and between-visit contact with the patient?

□
0□
d□
1

Yes
No
Don’t know

[Type text]

F. FUTURE PLANS

26.

Which of the following statements best describes your plans over the next five years? I am likely
to… (Mark only one.)

□

Increase the number of patients with HIV I serve

□

Decrease but not eliminate the number of patients with HIV I serve

□

Stop serving patients with HIV altogether

□

Continue serving the same number of patients with HIV

1

2

3

4

GO TO Q.26a
GO TO Q.26b

GO TO Q.26b
GO TO Q.27

26a. From the list below, select the three most significant reasons why you are likely to increase the
number of patients with HIV you serve in the next five years. (Mark only three.)
1

2

3

4

5

6

7

8

9

□

Number of patients seeking care at my practice is growing

□

Changes in practice patterns at my clinic enable me to take on more patients

□

Personal interest in providing care to more patients with HIV/AIDS

□

Training prepared me to increase my HIV/AIDS patient caseload

□

Loss of other clinicians in my practice able or willing to care for patients with HIV/AIDS

□

New or additional funding to support increased treatment time

□

Reducing number of non-HIV patients I serve

□

Increase my earnings

□

Other (Please specify)

_______________________________________

26b. From the list below, select the three most significant reasons why you are likely to reduce the
number of patients with HIV you serve or stop serving patients altogether in the next five years.
(Mark only three.)
1

2

3

4

5

6

7

□ Too much time spent on documentation and other administrative work
□ Pressure to see more patients with HIV or AIDS
□ Insufficient reimbursement rates or public funding for HIV/AIDS care
□ Uninsured and/or underinsured patients in my practice
□ Work schedule and/or on-call responsibilities
□ Medical liability and malpractice issues
□ Effort keeping up with clinical and/or pharmaceutical advances

[Type text]

8

9

10

11

27.

□ Shifting into other medical specialty
□ Retiring from medical practice
□ Other (Please specify)

___________________________

If reimbursement rates or public funding for treating patients with HIV were increased by 10 percent
in the next five years, how likely would you be to expand the number of patients with HIV or AIDS
you serve beyond your current plans indicated in Q.26? (Mark only one.)
1

2

3

4

28.

□ Increasing health care complexity of my HIV patients

□

Very likely

□

Somewhat likely

□

Somewhat unlikely

□

Very unlikely

How likely are you to retire from the health profession entirely within the next five years? (Mark only
one.)
1

2

3

4

□

Very likely to retire

□

Somewhat likely to retire

□

Somewhat unlikely to retire

□

Very unlikely to retire

[Type text]

G. YOUR PERCEPTION ABOUT HIV CLINICIAN CAPACITY

29.

In your opinion, the supply of clinicians providing direct medical care to patients with HIV or AIDS in
your community is currently…? (Mark only one.)

□
2□
3□
1

30.

Greater than demand (clinician surplus)
Balanced with demand
Less than demand (clinician shortage)

Using a scale of 1 – 5, where 1 means you strongly disagree with the statement and 5 means you
strongly agree with it, please rate this statement: I am concerned about a shortage in the number of
clinicians providing direct medical care to patients with HIV or AIDS in my community over the next
5 years. (Mark only one for each type of clinician.)
Strongly
Disagree

1

□. Infectious disease specialists

2

□. Physicians (other than infectious disease
specialists)

Strongly
Agree

1

□

2

□

3

□

4

□

5

□

1

□

2

□

3

□

4

□

5

□

3

□. Nurse practitioners

1

□

2

□

3

□

4

□

5

□

4

□

1

□

2

□

3

□

4

□

5

□

29.

Physician assistants

On a scale of 1 to 5 where 1 is least effective and 5 is most effective, please rate the effectiveness
of the following strategies for meeting a future increase in the demand for HIV-related medical
services without compromising the quality of care provided.
Least
Effective

1

2

3

4

□
□
□
□

Most
Effective

Training more medical and other health
profession students to go into HIV/AIDS
care

1

□

2

□

3

□

4

□

5

□

Increasing professional opportunities for
clinicians currently providing HIV/AIDS
care

1

□

2

□

3

□

4

□

5

□

Increasing the use of nurse practitioners
and physician assistants in managing
care for patients with HIV or AIDS

1

□

2

□

3

□

4

□

5

□

Increasing the use of social workers,
counselors, and patient educators to
improve linkages with and engagement,
adherence, and retention in HIV/AIDS
care

1

□

2

□

3

□

4

□

5

□

[Type text]

5

6

7

8

9

□
□

□
□
□

10

Reducing the amount of time spent
completing paperwork and meeting other
regulatory requirements

1

□

2

□

3

□

4

□

5

□

Increasing the adoption of health
information technology, including sharing
medical records, ordering prescriptions,
and ordering and receiving lab tests

1

□

2

□

3

□

4

□

5

□

Increasing the use of telemedicine for
treating patients in care settings without
adequate HIV expertise

1

□

2

□

3

□

4

□

5

□

Expanding the government loan
forgiveness program for clinicians
providing care to patients with HIV/AIDS

1

□

2

□

3

□

4

□

5

□

Increasing the use of non-HIV primary
care physicians for the treatment of
patients with HIV or AIDS

1

□

2

□

3

□

4

□

5

□

1

□

2

□

3

□

4

□

5

□

1

□

2

□

3

□

4

□

5

□

1

□

2

□

3

□

4

□

5

□

1

□

2

□

3

□

4

□

5

□

1

□

2

□

3

□

4

□

5

□

□ Increasing the use of advanced primary
care practice models intended to promote
the management of HIV disease,
including medication therapy
management

11

□ Increasing public funding and/or
reimbursement rates for HIV-related
health care services

12

□ Implementing appointment scheduling
changes intended to increase the number
of patients who can be seen

13

□ Creating incentives for currently
practicing clinicians to delay retirement or
prevent them from shifting out of HIVrelated medical care

14

. Other (Please specify)
______________________________

[Type text]

H. YOUR DEMOGRAPHIC CHARACTERISTICS

31.

What is your gender?

□
2□
1

32.

Male
Female

What is your current age (in years)?
|___ |___ | YEARS

33.

Are you Hispanic or Latino/Latina?

□
0□
1

34.

No

What is your race? (Mark all that apply.)

□
2□
3□
4□
5□
6□
1

35.

Yes

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Other (Please specify)

What is your current annual income? (Mark only one.)

□ Less than $75,000
3 □ $75,000 – $99,999
4 □ $100,000 – $124,999
5 □ $125,000 – $149,999
6 □ $150,000 – $199,999
7 □ $200,000 – $224,999
8 □ $225,000 – $249,999
9 □ $250,000 – $299,999
10 □ $300,000 – $349,999
11 □ Over $350,000
1

[Type text]

I. YOUR CONTACT INFORMATION

In case we need to contact you to clarify any of your answers:

Name:
Address:

Phone Number: |

|

|

Area Code

|-|

|

|

|-|

|

|

|

|

Number

Email Address: __________________ @ ______ . _____

[Type text]