Data Collection Survey

Question Title

* 1. What is your position?

Pharmacist

Technician

Student Pharmacist

Other

Question Title

* 2. What is your primary practice setting?

Community or retail

Ambulatory or outpatient clinic

Inpatient or hospital

Other

Question Title

* 3. What public health district is your primary practice setting located?

District 1 (Boundary, Bonner, Kootenai, Benewah, Shoshone counties)

District 2 (Latah, Clearwater, Nez Perce, Lewis, Idaho counties)

District 3 (Adams, Washington, Payette, Gem, Canyon, Owyhee counties)

District 4 (Valley, Boise, Ada, Elmore counties)

District 5 (Camas, Blaine, Gooding, Lincoln, Jerome, Minidoka, Twin Falls, Cassia counties)

District 6 (Butte, Bingham, Power, Bannock, Caribou, Oneida, Franklin, Bear Lake counties)

District 7 (Lemhi, Custer, Clark, Fremont, Jefferson, Madison, Teton, Bonneville counties)

Question Title

* 4. Select the conditions that you currently provide medication management services for. Select all that apply.

Diabetes

Hypertension

Hyperlipidemia

Other

Not applicable - do not currently provide medication management services

Question Title

* 5. Will this activity/CE increase your ability to provide medication management services for people with DIABETES in the next 30 days?

Definitely will not

Probably will not

Might or might not

Probably will

Definitely will

Question Title

* 6. Will this activity/CE increase your ability to provide medication management services for people with DIABETES in the next year?

Definitely will not

Probably will not

Might or might not

Probably will

Definitely will

Question Title

* 7. Will this activity/CE increase your ability to provide medication management services for people with HYPERTENSION in the next 30 days?

Definitely will not

Probably will not

Might or might not

Probably will

Definitely will

Question Title

* 8. Will this activity/CE increase your ability to provide medication management services for people with HYPERTENSION in the next year?

Definitely will not

Probably will not

Might or might not

Probably will

Definitely will

Question Title

* 9. Will this activity/CE increase your ability to provide medication management services for people with HYPERLIPIDEMIA in the next 30 days?

Definitely will not

Probably will not

Might or might not

Probably will

Definitely will

Question Title

* 10. Will this activity/CE increase your ability to provide medication management services for people with HYPERLIPIDEMIA in the next year?

Definitely will not

Probably will not

Might or might not

Probably will

Definitely will

Data Collection Survey

Question Title

* 1. What is your position?

Question Title

* 2. What is your primary practice setting?

Question Title

* 3. What public health district is your primary practice setting located?

Question Title

* 4. Select the conditions that you currently provide medication management services for. Select all that apply.

Question Title

* 5. Will this activity/CE increase your ability to provide medication management services for people with DIABETES in the next 30 days?

Question Title

* 6. Will this activity/CE increase your ability to provide medication management services for people with DIABETES in the next year?

Question Title

* 7. Will this activity/CE increase your ability to provide medication management services for people with HYPERTENSION in the next 30 days?

Question Title

* 8. Will this activity/CE increase your ability to provide medication management services for people with HYPERTENSION in the next year?

Question Title

* 9. Will this activity/CE increase your ability to provide medication management services for people with HYPERLIPIDEMIA in the next 30 days?

Question Title

* 10. Will this activity/CE increase your ability to provide medication management services for people with HYPERLIPIDEMIA in the next year?

Question Title

* 11. Please provide details on why this activity/CE will/will not increase your ability to provide medication management services.