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