9 Attachment I: Draft Interview Guide for Semi-Structured

Draft Interview Guide

This interview guide includes four core domains that are intended to capture characteristics of health care providers (physicians, nurse practitioners, and physician assistants) and their perception of the AHRQ Safety Program for Telemedicine: Improving Antibiotic Use (“the Safety Program”) on pre- and post-implementation changes. This guide will be refined to reflect differences between health care providers and key support staff. It will also be refined to reflect differences in telemedicine settings. Finally, this guide can be amended for length and comprehensibility of questions. All interviews will occur at the end of the intervention period.

Warm Up/Demographics

• What is your job title?

• How long have you been working at this practice?

• How long have you been using telemedicine?

• What is your background education and training in?

• What year did you start practicing independently (post-training, i.e., residency and/or fellowship)?

• In your own words, what is antibiotic stewardship? Have you heard this phrase before? If yes, what does it mean to you?

Implementation of the AHRQ Safety Program for Telemedicine: Improving Antibiotic Use

• Did your practice have any antibiotic stewardship efforts underway prior to implementation of the Safety Program? If yes, what were they?

• How ready do you think your practice was to implement the Safety Program?

• Did you think it was necessary for your practice to implement this intervention? Please explain.

• Are there other patient safety and quality improvement initiatives going on at your practice? If so, what are they?

• How much leadership support do you feel that you have for improving patient safety and quality?

• What could leadership be doing better, if anything, and what do you think the barriers are to getting them involved?

• What are the greatest successes and/or challenges you have experienced in implementing the Safety Program?

  • ADD SPECIFIC QUESTIONS HERE ABOUT DIFFERENT ELEMENTS OF INTERVENTION – EDUCATIONAL MODULES, FAMILY EDUCATION MATERIALS, “NUDGE” POSTERS, TIME OUTS, CHECKLISTS, POCKET CARDS, ETC.

• What is your opinion of the Safety Program?

  • Do you think it has impacted how you think about and prescribe antibiotics? If so, how?

  • Do you think it has impacted your practice? If so, how?

• What are your thoughts on the “The Four Moments of Antibiotic Stewardship”?

Prescribing Etiquette, Social Norms and Decision-Making Around Antibiotics

• What are the biggest barriers to the more judicious use of antibiotics within a telemedicine setting?

• What are the biggest facilitators of more judicious use of antibiotics within a telemedicine setting?

• How do you view your own antibiotic prescribing levels and patterns in relation to others? Does it differ when in a telemedicine setting?

• Do you feel you have had sufficient education and training on antibiotic prescribing and management within a telemedicine setting?

• Do you feel that you can comment on the antibiotic prescribing decisions of your colleagues?

• Who, in your view, is responsible for making sure the prescribing and management of antibiotics is optimal in a telemedicine setting?

  • How clear do you think this responsibility is?

• What do you think could be done on an organizational level to improve antibiotic prescribing in the telemedicine setting?

• How do you make decisions about antibiotics when using telemedicine to see patients?

• Are there specific patient groups that you are more likely to prescribe antibiotics to than others when using telemedicine? If so, why?

• If you decide not to prescribe an antibiotic, what are the alternatives you consider?

• How do you keep up to date on new information about infections? What sources do you consult?

• What are your thoughts about the future of antibiotics in telemedicine?

The Role of Nursing in Stewardship

• What role do you think nurses can play in improving antibiotic prescribing? How, specifically, might they impact the use of antibiotics within a telemedicine setting?

• Did participation in the intervention change your opinion about how nurses and others who are not directly responsible for prescribing can contribute to improving antibiotic use within telemedicine?

Public reporting burden for this collection of information is estimated to average 1 hour per response, the estimated time required to complete the survey. 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: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

2