Educating Groups Influencing Generic Drug Use

Data to Support Drug Product Communications as Used by the Food and Drug Administration

Screeners

Educating Groups Influencing Generic Drug Use

OMB: 0910-0695

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Name __________________________________Phone _____________________
Address _______________________________Phone 2 ___________________
City/ State/ Zip ______________________Recruiter ___________________

INTRODUCTION
Hello, my name is ____________ and I am calling from Baltimore Research. We are an independent
marketing research firm located in Towson, Maryland. Today we are inviting a select group of people to
discuss reasons for choosing certain medicines for an FDA funded study. Let me assure you that this is a
professional research study and not sales related in any way. If you qualify, you will receive financial
compensation for your time and input. May I ask you a few questions to see if you qualify?
1. RECORD GENDER. DO NOT ASK.
• Male
• Female
RECRUIT AT LEAST 3 FEMALES & 3 MALES
2. Which range does your age fall into?
• Under 19 THANK & TERMINATE
• Between 19 and 64 CONTINUE
• 65 or older CONTINUE
• Refused THANK & TERMINATE
RECRUIT AT LEAST 3 BETWEEN THE AGES OF 19 AND 64 AND 65 OR OLDER
RECRUIT A MIX
3. Have you been prescribed a medication within the last month?
• Yes CONTINUE TO Q4
• No SKIP TO Q3a
a. Are you currently caring for someone who has been prescribed a medication within the last
month?
• Yes CONTINUE
• No THANK & TERMINATE
RECRUIT AT LEAST 2 CAREGIVERS
THE FOLLOWING QUESTIONS ARE FOR CLASSIFICATION PURPOSES ONLY
4. Which best describes your race?

•
•
•
•
•
•
•
•

White or Caucasian CONTINUE
Black or African American CONTINUE
Asian CONTINUE
American Indian or Alaska Native CONTINUE
Native Hawaiian or other Pacific Islander CONTINUE
Some other race CONTINUE
Two or more races CONTINUE
Refused THANK & TERMINATE

RECRUIT A REPRESENTATIVE MIX
5. Which best describes your employment situation?
• Employed Full-Time CONTINUE
• Employed Part-Time CONTINUE
• Do not work outside the home CONTINUE
• Retired CONTINUE
• Laid off or unemployed CONTINUE
• Refused THANK & TERMINATE
RECRUIT A MIX
6. Which best describes your education level?
• Some high school CONTINUE
• High school diploma/GED CONTINUE
• Some college CONTINUE
• Bachelor’s degree CONTINUE
• Graduate degree CONTINUE
• Refused THANK & TERMINATE
INVITATION: Thank you for answering my questions. I’m pleased to inform you that you do qualify to
participate in our study. Researchers from Auburn University and IMPAQ International are conducting
60-minute discussions between October 1st and 31st. You will be speaking with a professional researcher
about your opinions which we expect would be both fun and interesting. For your time, we would be
able to offer you $50 upon completion of the session. Would you be interested in participating?
•
•

Yes CONTINUE
No THANK & TERMINATE

We will be sending you a letter with additional information related to the study and your role as a
participant. The letter is yours to keep and if you have any questions you may feel free to reach out to
one of the researchers listed on the letter. Would you like us to send the letter electronically via email,
in the mail or both?
RECRUITER NOTE: TAKE DOWN INFORMATION AND PREFERENCE TO SEND LETTER.

RECRUITER NOTE: PLEASE ONLY RECRUIT ARTICULATE AND CHATTY RESPONDENTS. DO NOT HESITATE
TO TERMINATE A RESPONDENT WHO YOU DO NOT BELIEVE WILL CONTRIBUTE INSIGHTFUL
INFORMATION TO THE DISCUSSION.

Name __________________________________Phone _____________________
Address _______________________________Phone 2 ___________________
City/ State/ Zip ______________________Recruiter ___________________

INTRODUCTION
Hello, my name is ____________ and I am calling from Baltimore Research. We are an independent
marketing research firm located in Towson, Maryland. Today we are inviting a select group of people to
discuss their opinions about why your choices in medication for an FDA funded study. Let me assure you
that this is a professional research study and not sales related in any way. If you qualify, you will receive
financial compensation for your time and input. May I ask you a few questions to see if you qualify?
1. Record Gender (DO NOT ASK)
Male
Female
2. Record age ________
3. What is your primary medical specialty? (DO NOT READ LIST; SELECT ONE ANSWER)
MD
Pharm

RECRUIT AT LEAST 9 OF EACH

4. What is your level of certification within your specialty? (SELECT ONE)
Board certified
Board eligible
Neither
Pharmacy Cert

1
2
3
4

5. How many years have you been in medical practice post-residency (physician only) or pharmacy
practice (pharmacist only)? (DO NOT ACCEPT RANGE)
______ Years
Pharm skip to 9
6. What proportion of your professional time do you spend performing each of the following
activities? (Doctor)
Direct patient care
Research or teaching
Administrative duties
Other

%
%
%
%

7. Are you primarily based in a (SELECT ONE)
Hospital
Private Practice
Other

RECRUIT AT LEAST 3 HOSPITAL-BASED AND 3 PRIVATE PRACTICE

8. Have you prescribed a medication within the last two weeks?
Yes
No

CONTINUE
THANK & TERMINATE

8a. What was the last generic drug you prescribed?
__________________________________________________
8b. When did you write that prescription?
____________________________________________________

Pharm Only
9. What proportion of your professional time do you spend performing each of the following
activities? (Pharmacist)
Direct patient care
Research or teaching
Administrative duties
Other

%
%
%
%

10. Are you primarily based in a (SELECT ONE)
Hospital
Large Retailer
Community-based Pharmacy
Other

RECRUIT AT LEAST 2 HOSPITAL-BASED AND 2 LARGE RETAILER AND 2 COMMUNITY-BASED
11. Have you dispensed a medication within the last two weeks?

Yes
No

CONTINUE
THANK & TERMINATE

11a. What was the last generic drug you dispensed?
__________________________________________________
11b. When did you dispense it?
____________________________________________________

INVITATION: Thank you for answering my questions. I’m pleased to inform you that you do qualify to
participate in our study. Researchers from Auburn University and IMPAQ International are conducting 60minute discussions between October 1st and 31st. You will be speaking with a professional researcher
about your opinions which we expect would be both fun and interesting. For your time, we would be able
to offer you $___ upon completion of the session. Would you be interested in participating?

•
•

Yes CONTINUE
No THANK & TERMINATE

We will be sending you a letter with additional information related to the study and your role as a
participant. The letter is yours to keep and if you have any questions you may feel free to reach out to
one of the researchers listed on the letter. Would you like us to send the letter electronically via email,
in the mail or both?
RECRUITER NOTE: TAKE DOWN INFORMATION AND PREFERENCE TO SEND LETTER.

RECRUITER NOTE: PLEASE ONLY RECRUIT ARTICULATE AND CHATTY RESPONDENTS. DO NOT
HESITATE TO TERMINATE A RESPONDENT WHO YOU DO NOT BELIEVE WILL CONTRIBUTE INSIGHTFUL
INFORMATION TO THE DISCUSSION.


File Typeapplication/pdf
AuthorJennifer Howard
File Modified2016-03-11
File Created2016-03-11

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