6.5 KiB
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 (multi-select): Private Clinic / Private Hospital / Govt. Hospital / Other (please specify): ______
- Specialization (single choice): Chest Physician / Consulting Physician / Other (specify): ______
- City: ______
- State (dropdown): all Indian states and union territories
Section 2: Physician Practice Profile
- On an average, how many patients do you see per month? ______
- Approximately how many asthma patients do you manage per month?
- New patients: ___
- Follow-up/old patients: ___
- Approximately how many COPD patients do you manage per month?
- New patients: ___
- Follow-up/old patients: ___
Section 3: Foracort Prescribing Pattern
-
Approximately what proportion of your asthma patients receive Formoterol/Budesonide? ___ %
-
Approximately what proportion of your COPD patients receive Formoterol/Budesonide? ___ %
-
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
-
Among your patients receiving Formoterol/Budesonide, approximately what proportion do you prescribe (each column must total 100%):
Regular Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 30) and MDI (120 doses). Extended-Dose Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 60) and MDI (180 doses).
| 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
-
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.
Regular Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 30) and MDI (120 doses). Extended-Dose Pack: Formoterol/Budesonide 200 & 400 mcg – Rotacaps (pack of 60) and MDI (180 doses).
| 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 |
- 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
- 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
- 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
-
What do you consider the main advantages / disadvantages of the Extended-Dose Pack compared to the Regular Pack?
- Advantages: ______
- Disadvantages: ______
-
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)
- Using an Extended-Dose Pack is more convenient for patients
- Using an Extended-Dose Pack reduces the frequency of medication refills
- Using an Extended-Dose Pack improves medication adherence
- Using an Extended-Dose Pack helps in maintaining treatment continuity
- Using an Extended-Dose Pack improves patient satisfaction
- Using an Extended-Dose Pack helps achieve better disease control
- Using an Extended-Dose Pack is more cost-beneficial for patients because it reduces the frequency of doctor visits
- Using an Extended-Dose Pack may be detrimental because it can delay follow-up visits with the doctor
- Patients are reluctant to bear the higher initial purchase amount
- 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.