2 Clinical Survey

Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings

B_Clinician Survey

Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings

OMB: 0906-0018

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Appendix B: Clinician Survey

OMB No. 0906-XXXX
Expiration date: XX/XX/201X


Providing Primary Care and Preventive Medical Services in Ryan White-funded Medical Care Settings:

Clinician Survey


Supported by the Health Resources and Services Administration, HIV/AIDS Bureau

Contract Number: HHSH250201400042I







Public Burden Statement:  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.  The OMB control number for this project is 0906- XXXX.  Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.




Clinician Survey





Instructions:

You are completing this online survey via SNAP Survey. You will also be able complete the survey at your own pace. If you need to close out of the survey and complete it at another time, simply close the tab or browser and your answers will be saved. You will be able to log into your survey with the same login and password as you entered.


Please choose your answers from the response options provided. Only choose one answer unless you are asked to choose ALL that apply. Some response options will also include “Other” in which you are provided space to supply an explanation.



Terminology: The terms may differ from provider and institution, but for this survey we are using the following four terms and definitions throughout the document:



  1. HIV Specialist: Physician or provider specializing in infectious disease with AAHIVM, HIVMA, or AARN certifications

  2. Primary Care Provider: Medical doctor, Doctor of osteopathic medicine, general practitioner, physician’s assistant and/or nurse practitioner

  3. Care Coordination Team: Team comprised of multi-disciplinary providers who meet to discuss management of patients care.

  4. Comprehensive Physical Exam and Health Maintenance: Comprehensive physical exam and health maintenance includes annual complete physical exam, screenings, review of systems, medical history review, and education and counseling services.



If you need any assistance in completing the survey, please contact:



West Coast: Vicki Wheeler, Tel: (415) 814-1557, Email: [email protected]

East Coast: Aaron Lane, Tel: (301) 881-2590, Email: [email protected]




Thank you for your time.


Primary Care Online Survey

Clinician



Respondent Information (for follow-up purposes only)



Respondent Name _________________________________________________________________________________________________



Ryan White-funded Clinic Name______________________________________________________________________________________



Respondent's telephone number (include area code, phone number, and extension, if applicable) ___________________________________



Respondent's email address__________________________________________________________________________________________

  1. What is your area of practice? (Please choose ALL that apply.)

Primary Care Provider (M.D., D.O. or other physician level license: general practitioner, physician’s assistant and/or nurse practitioner)

HIV Specialist (specializing in infectious disease with certifications in the following: AAHIVM, HIVMA, or AACRN)

Nurse Practitioner

Physician’s Assistant

Internal Medicine

Family Practice

Infectious Disease

General Practitioner

Other: ______________


  1. What is your current case load?


Between 0 – 500

Between 501 – 1,000

Between 1,001 – 1,500

Between 1,501 – 2,000

2,001 plus




  1. What percentage of your case load are people living with HIV (PLWH)?



Between 0 – 20%

Between 21 – 40%

Between 41 – 59%

Between 60 – 79%

Between 80 – 99%

100%



  1. Does your clinic provide primary and preventative care services to PLWH patients? (For a list of primary care services see Q8 or attachment)


Yes, we provide all primary and preventative care services to PLWH at our clinic (Go to Q5)

Yes, but we refer PLWH to providers outside our clinic for some primary and preventative care services (Go to Q4a, 4b, 4c, and 4d)

No, we refer PLWH to providers outside our clinic for all primary and preventative care services (Go to Q4a, 4b, 4c, and 4d)



4a. What are the reasons for referring primary and preventative care services outside of your clinic? (Please choose ALL that apply.)


We do not have primary medical services for particular patient conditions on site (Hepatitis B and C, heart disease, metabolic disorders, OB-GYN, etc.)


We do not provide preventative care services


We do not provide HIV medical care


Other _______________________________________



4b. What are your reasons for referring services to a specific provider?


Provider accepts insurance

Appointment availability

Provider reputation

Patient preference

Provider location

Provider is part of clinic’s referral system

Other__________________________________


4c. PLWH are referred to the following providers: (Please choose ALL that apply.)


Providers outside of the clinic, but within our healthcare system

Providers outside of our healthcare system



4d. Do you receive patient information such as impressions of exam, test results and treatment plans from referred providers?

Never

Yes, between 1 – 20% of the time

Yes, between 21 – 40% of the time

Yes, between 41 – 59% of the time

Yes, between 60 – 79% of the time

Yes, between 80 – 99% of the time

Yes, 100% of the time



  1. Does your clinic have a protocol for providing primary care services, including preventive services, for PLWH?


Yes (Go to Q5_1, 5_2, 5_3)

No (Go to Q6)

Don’t know (Go to Q6)














What services listed below are part of your clinic’s provision of primary and preventative care to PLWH. (Please choose ALL that apply.)


Primary and Preventive Care Service

5_1. Is this service part of your provision of primary and preventive care to PLWH?

5_2.For services listed that you do not provide or play a major role in, do you delegate these services to other staff in the clinic?

5_3. To whom do you delegate these services to? Please choose all that apply.

  1. Providing routine health maintenance (including physical exams, diagnostic screenings, and lab assessments)

Yes (go to 5_2 and 5_3)


No, I refer this service to another provider at a clinic operated by our same healthcare system (go to 5_2 and 5_3)


No, I refer this service to another provider at a clinic outside our healthcare system (go to 5_2 and 5_3)


Other:_______

Never

Yes, between 1 – 20% of the time

Yes, between 21 – 40% of the time

Yes, between 41 – 59% of the time

Yes, between 60 – 79% of the time

Yes, between 80 – 99% of the time

Yes, 100% of the time

I perform the service


Nurse Practitioner or Physician’s Assistant


Registered Nurse


Medical Assistant


Lab Technician


Care Coordinator/Case Manager/Social Worker


Other: ________

  1. Monitoring of age and sex/gender specific health problems (e.g. colorectal screening, prostate screening, mammograms)

  1. Medication management in addition to HIV antiretroviral therapy

  1. Health promotion or prevention services such (e.g. diet, nutrition and exercise, safer sex practices, immunization recommendations, etc.)

  1. Behavioral health screening and counseling such as mental health and substance use

  1. Care Coordination via a team comprised of multi-disciplinary providers who meet to discuss management of patients care

  1. Medical Case management

  1. Non-medical Case management









  1. How often do your clinicians typically perform a comprehensive physical exam and health maintenance with PLWH? (Please check ALL that apply.)


Every visit

As part of a patient’s first care appointment

Annually

Perform parts of physical exam more than once a year as appropriate due to patient’s medical condition (e.g., comorbidity, viral load and CD4 count)

I do not provide complete physical exams

Other ___________________


  1. What services are included in your comprehensive physical exam and health maintenance? (Please choose ALL that apply.)


Comprehensive Physical Exam Service and Health Maintenance

7_1. Is this service part of your physical exam service to PLWH?

7_2. Do you delegate service to other staff in the clinic?

7_3. To whom do you delegate these services to? Please choose all that apply.

a. Vital Signs

Yes (go to 7_2 and 7_3)


No, I refer this service to another provider at a clinic operated by our same healthcare system (go to 7_2 and 7_3)


No, I refer this service to another provider at a clinic outside our healthcare system (go to 7_2 and 7_3)


Other:_______ (go to 7_2 and 7_3)

Never

Yes, between 1 – 20% of the time

Yes, between 21 – 40% of the time

Yes, between 41 – 59% of the time

Yes, between 60 – 79% of the time

Yes, between 80 – 99% of the time

Yes, 100% of the time

I perform the service


Nurse Practitioner or Physician’s Assistant


Registered Nurse


Medical Assistant


Lab Technician


Care Coordinator/Case Manager/Social Worker


Other: ________

b. Weight/BMI

c. Pain assessment (arthritis, lower back pain, etc.)

d. Ears, Nose, and Throat exam

e. Pulmonary Exam

f. Cardiac Exam

g. Musculoskeletal Exam

h. Oral Exam

i. Genital Exam

j. Depression and Mental Health Screening

k. Tobacco Use Screening and Counseling

l. Substance Use Screening and Counseling

m. Medical Nutrition Therapy/Behavioral Counseling to Promote a Healthy Diet

n. Accident prevention (falls, seatbelts, etc.)

o. Routine lab tests (complete blood count, basic metabolic panel, and liver function test, etc.)





  1. For each primary care service, please answer how the service is provided. (Please choose ALL that apply to each question.)


Primary Care Service

8_1. Do you provide this service to PLWH?

8_2. Who else provides this service at your clinic to PLWH? (Please choose ALL that apply)

8_3. How often do you provide service to PLWH?

8_4. When you refer PLWH to another provider, is patient information shared with the outside referral?

8_5. When PLWH are referred to another provider, do you receive patient information back from the provider?

8_6. How do you share information with other providers outside of your clinic?

a. Breast Cancer Screening

Yes (go to 8_3)


No, I refer this service to another provider at a clinic operated by our same healthcare system (go to 8_4, 8_5, and 8_6)


No, I refer this service to another provider at a clinic outside our healthcare system (go to 8_4, 8_5, and 8_6)


Other:_______ (go to 8_2, 8_3, 8_4, 8_5, and 8_6)

Primary Care Provider


HIV Specialist


Other Medical Specialist


Registered Nurse


Nurse Practitioner


Physician’s Assistant


Other: ________

Annually


Less than annually


Only when patient exhibits symptoms


More than once a year when appropriate due to patient’s medical condition


Other:______


Yes, with clinic operated by our same healthcare system


Yes, with clinic outside our healthcare system


No, (please explain)________


Other:_______

Yes, with clinic operated by our same healthcare system


Yes, with clinic outside our healthcare system


No, (please explain)________


Other:_______

Through EMRs or other electronic means


Clinic staff follow up with referred clinic/provider


No, we do not share information with other providers


Other:_____

b. Cervical Cancer (including HPV Screening)

c. Cholesterol

d. Colorectal Cancer Screening

e. Diabetes Screening

f. Gonorrhea and Chlamydia Screening

g. Hepatitis B Screening

h. Hepatitis C Screening

i. Mental Health Screening

j. Osteoporosis Screening

k. Prostate Cancer Screening

l. Routine Vaccinations (Flu, Pneumococcal, Tetanus, Pertussis, etc.)

m. Substance Use Screening

n. Syphilis Screening

o. TB Screening



  1. For PLWH who have co-morbidities, please answer how you manage each disease listed below. (Please choose ALL that apply to each question.)

Disease

9_1. Do you manage the disease in-house for PLWH?

9_2. Who else is involved in managing this disease with the PLWH?

9_3.How do the various clinicians involved in the care management share patient information?

9_4. When you refer PLWH to another provider, is patient information shared with the outside referral?

9_5. When PLWH are referred to another provider, do you receive patient information back from the provider?

9_6. How do you share information with other providers outside of your clinic?

  1. Cardiovascular

Yes (go to 9_2 and 9_3)


No, we refer PLWH to another provider at a clinic operated by our same healthcare system (go to 9_4, 9_5, and 9_6)


No, we refer PLWH to another provider at a clinic outside our healthcare system (go to 9_4, 9_5, and 9_6)


Other:_______ (go to 9_2, 9_3, 9_4, 9_5, and 9_6)

Primary Care Provider

HIV Specialist

Other Medical Specialist

Registered Nurse

Nurse Practitioner

Physician’s Assistant

Care

Coordinator/ Case Manager

Clinical Pharmacist

Other:_____

Through EMRs or other electronic means


Via regular meetings


Other:____

Yes, with clinic operated by our same healthcare system


Yes, with clinic outside our healthcare system


No, (please explain)________


Other:_______

Yes, we always receive information back


Sometimes

It depends on the clinic


Yes, with clinic operated by our same healthcare system


Yes, with clinic outside our healthcare system (FQHC could use this if it applies)


No, (please explain)_________


Other:_______

Through EMRs or other electronic means


Clinic staff follow up with referred clinic/provider


No, we do not share information with other providers


Other: ____

  1. Diabetes

  1. Hypertension

  1. Thyroid

  1. Respiratory

  1. Hepatitis C

  1. Renal




  1. What elements from the list below are part of your provision of primary care to PLWH with co-morbidities? (Please choose ALL that apply.)


Consult with HIV Specialist (Go to Q11)

Use of Care Coordinator/Case Manager (Go to Q11)

Use of Care Team model to share information and manage patient care (Go to Q10a)

Follow up to share information with other specialists or medical professionals outside clinic involved in patient care (Go to Q11)

Use of Clinical Pharmacist (Go to Q11)

Use of specialists (hepatologist, cardiologist, gastroenterologist, gynecologist, etc.) (Go to Q11)

Other ______________________________________ (Go to Q11)

None of the above (Go to Q11)



10a. Who are the members of the co-morbidities Care Team? A care team is comprised of a multi-disciplinary providers who meet to discuss management of patients’ care (Please choose ALL that apply.)

Primary Care Provider

HIV Specialist

Care Coordinator/Case Manager

Clinical Pharmacist

Specialists (Hepatologist, Gastroenterologist, Cardiologist, Endocrinologist, Psychiatrist, Gynecologist, etc...)



Mental Health Provider

Substance Use Counselor

Oral Health Provider

Other ____________________________



  1. What other specialists or other medical professionals’ do you consult or collaborate with to provide primary care to PLWH at your clinic? (Please choose ALL that apply.)



Primary Care Provider

HIV Specialist

Care Coordinator/Case Manager

Clinical Pharmacist

Specialists (Hepatologist, Gastroenterologist, Cardiologist, Endocrinologist, Psychiatrist, Gynecologist, etc...)

Mental Health Provider

Substance Use Counselor

Oral Health Provider

Other ____________________________






  1. What are your clinic’s strengths in providing primary care, including preventative services? (Please choose ALL that apply.)


Sufficient number of non-medical staffing

Sufficient number of primary care clinicians

Clinician training and expertise with primary and preventative care

Availability of HIV Specialists

Availability of other Medical Specialists

Care Team and Case Management located within the clinic

Ability to meet encounter ratio requirements

Sufficient linkages and referrals to other community resources

Co-location of some primary care and preventive care services

One-stop shopping

Funding to provide services not covered by insurance

Physical size of clinic

Other_____________________________________________



  1. What are your clinic’s challenges in providing primary care services, including preventative services? (Please choose ALL that apply.)


Lack of non-medical staffing

Lack of primary care clinicians

Unavailability of HIV Specialists

Unavailability of other Medical Specialists

Unavailability of Care Team and Case Management

Cannot take new patients because of size of current patient panel

Administrative work is too burdensome


Inability to meet encounter ratio requirements

Lack of linkages and referrals to other community resources

Lack of funding to provide services not covered by insurance

Lack of co-location of primary and preventive care services

Physical size of the clinic

Reimbursement rate is too low

Other_____________________________________________


  1. As a clinician, what are the challenges you face in providing primary and preventative care services to PLWH?

Lack of medical training and experience in the area of HIV

Lack of non-medical training and experience in the area of HIV (counseling and education services)

Lack of training and experience in primary and preventative care issues and management

Cannot take new patients because of size of current patient panel

Unavailability of HIV Specialists

Unavailability of other Medical Specialists

Lack of patient information sharing

Meeting encounter ratio requirements

Reimbursement rate is too low

Administrative work is too burdensome



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