Pre-implementation Provider Perception and Demand Survey 2.2.22

Assessment of a Pharmacist-Led Transitions of Care Service Utilizing an Admissions Enhanced Patient Risk Evaluation Approach: the ICARE Program

OMB Control Number: 0910-0847

Expiration Date: 12/31/2022

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Pre-implementation Provider Perception and Demand Evaluation

The following survey is anonymous. Please select the most appropriate answer for each of the following items.

What is your profession?

□ Physician □ Nurse Practitioner □ Nurse □ Physician Assistant □ Pharmacist □ Social Worker

□ Medical Assistant □ Other ___________________________

What is your medical specialty? __________________________

In your current position do you have administrative/financial responsibilities? □ Yes □ No

How long have you worked for East Alabama Medical Center (EAMC)?

□ 0-5 years □ 6-10 years

□ 11-15 years □ 16-20 years

□ 21+ years

1. Our facility effectively transitions patients from the inpatient to outpatient setting.

□ Strongly Agree □ Agree □ Disagree □ Strongly Disagree

2. Our facility would benefit from a dedicated transitions of care team.

□ Strongly Agree □ Agree □ Disagree □ Strongly Disagree

3. Transitions of care teams can reduce readmission rate.

□ Strongly Agree □ Agree □ Disagree □ Strongly Disagree

4. I can effectively work with the transitions of care team.

□ Strongly Agree □ Agree □ Disagree □ Strongly Disagree

5. The transitions of care team will help save me time.

□ Strongly Agree □ Agree □ Disagree □ Strongly Disagree

6. The transitions of care team will help improve patient care and outcomes.

□ Strongly Agree □ Agree □ Disagree □ Strongly Disagree

7. The implementation of the transition of care team will disrupt normal workflow.

□ Strongly Agree □ Agree □ Disagree □ Strongly Disagree

8. The most common error(s) occurring during care transitions at EAMC is/are:

□ Medication-related problems

□ Barriers to care (e.g., cost of medications, transportation, health literacy, etc.)

□ Communication between departments/outpatient settings

□ Other ________________________________________

9. How often do you interact with pharmacists?

□ Every workday □ Most days of the work week □ < 2x per week □ Rarely

10. How often do you interact with social workers?

□ Every workday □ Most days of the work week □ < 2x per week □ Rarely