117 lines
6.0 KiB
Markdown
117 lines
6.0 KiB
Markdown
# Study Questionnaire — Survey Questionnaire Version 01 (Date: 14/10/2026)
|
|
|
|
**CREST Pvt. Ltd. — Confidential**
|
|
|
|
**Study title:** Physicians' Perceptions of the Impact of an Extended-Dose Pack versus Regular Pack on Adherence to Inhaled Maintenance Medication in Asthma and COPD: A Cross-Sectional Survey
|
|
|
|
---
|
|
|
|
## Section 1: Basic Demographics / Doctor Details
|
|
|
|
- **Name:** ______
|
|
- **Qualification** (single choice): MBBS / MD (Chest) / DM (Pulmo / DNB / DCH) / MD (Med) / DNB (Med) / Any other (specify): ______
|
|
- **Years of Practice:** ______
|
|
- **Practice setting** (single choice): Private Clinic / Private Hospital / Govt. Hospital
|
|
- **Specialization** (single choice): Chest Physician / Consulting Physician / Other (specify): ______
|
|
- **City:** ______
|
|
- **State:** ______
|
|
|
|
## Section 2: Physician Practice Profile
|
|
|
|
1. On an average, how many patients do you see per month? ______
|
|
2. Approximately how many **asthma** patients do you manage per month?
|
|
- New patients: ___
|
|
- Follow-up/old patients: ___
|
|
3. Approximately how many **COPD** patients do you manage per month?
|
|
- New patients: ___
|
|
- Follow-up/old patients: ___
|
|
|
|
## Section 3: Foracort Prescribing Pattern
|
|
|
|
4. Approximately what proportion of your **asthma** patients receive Formoterol/Budesonide? ___ %
|
|
5. Approximately what proportion of your **COPD** patients receive Formoterol/Budesonide? ___ %
|
|
6. For how long have you been prescribing the Extended-Dose Pack to your patients with asthma and/or COPD? (single choice)
|
|
- [ ] Less than 6 months
|
|
- [ ] 6 months to less than 1 year
|
|
- [ ] More than 1 year
|
|
7. Among your patients receiving Foracort, approximately what proportion do you prescribe (each column must total 100%):
|
|
|
|
| Pack type | Product | Pack info | Asthma | COPD |
|
|
|---|---|---|---|---|
|
|
| Regular Pack | Formoterol/Budesonide 200 & 400 mcg pMDI | 120 doses (unit dose cost same for 120 and 180 dose packs) | ___% | ___% |
|
|
| Regular Pack | Rotacap | Pack of 30 (unit dose cost same for 30 and 60 dose pack) | ___% | ___% |
|
|
| Extended-Dose Pack | Formoterol/Budesonide 200 & 400 mcg pMDI | 180 doses (unit dose cost same for 120 and 180 dose packs) | ___% | ___% |
|
|
| Extended-Dose Pack | Rotacap | Pack of 60 (unit dose cost same for 30 and 60 dose pack) | ___% | ___% |
|
|
| **Total** | | | **100%** | **100%** |
|
|
|
|
## Section 4: Physician Assessment of Adherence
|
|
|
|
8. Based on your clinical experience, approximately what proportion of patients are adherent to their prescribed treatment? (Estimate out of 100 patients.)
|
|
|
|
*Note: A patient is considered "adherent" if the physician believes the patient takes at least 75% of the prescribed inhaled maintenance medication doses during a typical month of treatment.*
|
|
|
|
| Pack type | Product | Asthma | COPD |
|
|
|---|---|---|---|
|
|
| Regular Pack | Formoterol/Budesonide 200 & 400 mcg pMDI (120 doses) | ___ / 100 | ___ / 100 |
|
|
| Regular Pack | Rotacap (pack of 30) | ___ / 100 | ___ / 100 |
|
|
| Extended-Dose Pack | Formoterol/Budesonide 200 & 400 mcg pMDI (180 doses) | ___ / 100 | ___ / 100 |
|
|
| Extended-Dose Pack | Rotacap (pack of 60) | ___ / 100 | ___ / 100 |
|
|
|
|
9. Compared with patients receiving the regular pack, adherence among patients receiving the extended-dose pack is: (single choice)
|
|
- [ ] Much better
|
|
- [ ] Somewhat better
|
|
- [ ] No difference
|
|
- [ ] Somewhat worse
|
|
- [ ] Much worse
|
|
- [ ] Unable to assess
|
|
|
|
## Section 5: Reasons for Non-adherence
|
|
|
|
10. In your opinion, what are the key barriers to adherence to inhaled maintenance therapy of formoterol/budesonide in your asthma and COPD patients? (multi-select)
|
|
- [ ] Side effects
|
|
- [ ] Lack of understanding of the need for regular treatment
|
|
- [ ] Delay in refill due to poor accessibility
|
|
- [ ] Perception that medication is not required when symptoms improve
|
|
- [ ] Fear/concerns about long-term medication
|
|
- [ ] Cost
|
|
- [ ] Difficulty remembering to take doses
|
|
- [ ] Inhaler technique difficulties
|
|
- [ ] Patient lifestyle/work-related factors
|
|
- [ ] Other (specify): ______
|
|
|
|
## Section 6: Patient Characteristics Associated with Adherence
|
|
|
|
11. Which patients, in your opinion, are most likely to benefit from an Extended-dose pack? (multi-select)
|
|
- [ ] Elderly patients
|
|
- [ ] Difficulty accessing the pharmacy for a refill (e.g., remote location)
|
|
- [ ] Patients with frequent exacerbations
|
|
- [ ] Patients frequently forgetting doses
|
|
- [ ] Patients taking multiple medications
|
|
- [ ] Patients with poor disease awareness
|
|
- [ ] All patients requiring long-term maintenance therapy
|
|
- [ ] Busy lifestyle / working professional
|
|
- [ ] Frequent travellers
|
|
- [ ] Caregiver-dependent patients
|
|
- [ ] Other: ______
|
|
|
|
## Section 7: Physician Perspective on the Extended-Dose Pack
|
|
|
|
12. What do you consider the main advantages / disadvantages of the Extended-Dose Pack compared to the Regular Pack?
|
|
- Advantages: ______
|
|
- Disadvantages: ______
|
|
|
|
13. Overall, how would you rate the Extended-Dose Pack compared with the Regular Pack with respect to the following? (Likert scale per row: Strongly disagree / Disagree / Neither agree nor disagree / Agree / Strongly agree)
|
|
|
|
1. Using an adherence pack is more convenient for patients
|
|
2. Using an adherence pack reduces the frequency of medication refills
|
|
3. Using an adherence pack improves medication adherence
|
|
4. Using an adherence pack helps in maintaining treatment continuity
|
|
5. Using an adherence pack improves patient satisfaction
|
|
6. Using an adherence pack helps achieve better disease control
|
|
7. Using an adherence pack is more cost-beneficial for patients because it reduces the frequency of doctor visits
|
|
8. Using an adherence pack may be detrimental because it can delay follow-up visits with the doctor
|
|
9. Patients are reluctant to bear the higher initial purchase amount
|
|
10. Higher chance of damage to Rotacaps due to humidity in the extended-dose pack
|
|
|
|
> Note: In the source PDF, rows 9 and 10 appear without the rating options (the page appears cut off); they are presumably meant to use the same 5-point scale.
|