Form 3 Month Follow up 3 Month Follow up 0920-20LD

OMB Control No. 0920-1050

Exp. Date 05/31/2022

The public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to - CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (0920-1050).

The following questions will be asked of learners 3 months following completion of Module 1 as part of CDC’s training for “Applying CDC’s Guideline for Prescribing Opioids”.

Now that it has been approximately 3 months since you completed Module 1: Addressing the Opioid Epidemic: Recommendations from CDC, we would like to know how you have applied what you learned. Please take a moment to complete this short survey and provide your feedback in the comment boxes below.

		Response Options	Purpose:
	As a result of taking the CDC training, I can explain why an evidence-based guideline for prescribing opioids is needed.	Strongly Agree, Agree, Neither Agree, nor Disagree, Disagree, Strongly Disagree	Assess trainee self-report knowledge retention
	As a result of taking the CDC training, I can describe the key recommendations in the CDC guideline for prescribing opioids.	Strongly Agree, Agree, Neither Agree, nor Disagree, Disagree, Strongly Disagree	Assess trainee self-report knowledge retention
	As a result of taking the CDC training, I can explain benefits of implementing the CDC recommendations for prescribing opioids.	Strongly Agree, Agree, Neither Agree, nor Disagree, Disagree, Strongly Disagree	Assess trainee self-report knowledge retention
	As a result of taking the CDC training, I feel confident in my ability to talk with patients about the risks associated with opioid use.	Strongly Agree, Agree, Neither Agree, nor Disagree, Disagree, Strongly Disagree	Assess trainee confidence in talking with patients about opioid use.
	Before this training, I was very knowledgeable overall about the risks of opioid prescribing for chronic pain.	Strongly Agree, Agree, Neither Agree, nor Disagree, Disagree, Strongly Disagree	Assess baseline perceived level of knowledge of opioid prescribing.
	After this training, I consider myself more knowledgeable overall about the risks of opioid prescribing for chronic pain.	Strongly Agree, Agree, Neither Agree, nor Disagree, Disagree, Strongly Disagree	Assess post-training perceived level of knowledge of opioid prescribing.
	Since completing the module:
	I prescribe opioids for chronic pain...	More Frequently, At about the same frequency, or Less Frequently	Assess trainee change in prescribing behavior
	I prescribe nonpharmacologic treatments (such as physical therapy, behavioral therapy) for chronic pain…	More Frequently, At about the same frequency, or Less Frequently	Assess trainee change in behavior
	I discuss with my patients the risks associated with opioid use…	More Frequently, At about the same frequency, or Less Frequently	Assess trainee change in behavior
	What changes have you made/action taken as a result of the training?	Open Ended (Text Box)	Assess trainee perceived barriers to applying what they learned
	Describe barriers you have encountered when applying what you learned from the CDC training	Open Ended (Text Box)	Assess trainee behavior changes that resulted from training
	What would help you implement what you learned from the CDC training?	Open Ended (Text Box)

Add one additional question to post course evaluation for all modules in the “Applying CDC’s Guideline for Prescribing Opioids.”

	A	B	C	De	E	N/A
How did you learn about this training module? Email from CDC Email from professional organization Professional organization website CDC TRAIN Other, please indicate below						