Survey of AJM Readers - Pain Management Mentoring

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1. What is your practice type?

What is your practice type?   MD/DO PA/NP

Other (please specify)

2. What is your area of specialization?

What is your area of specialization?   Internal Medicine Family Medicine

Other (please specify)

3. What percentage of your current patients are chronic pain patients to whom you actively provide coordination of care and pain medications?

What percentage of your current patients are chronic pain patients to whom you actively provide coordination of care and pain medications?   <10% 10 to 25% 25 to 50% >50%

4. What percentage of your patients with chronic pain do you actively treat by prescribing long-term controlled substances?

	<10%	10 to 25%	25 to 50%	>50%
Schedule II	*What percentage of your patients with chronic pain do you actively treat by prescribing long-term controlled substances? Schedule II <10%	Schedule II 10 to 25%	Schedule II 25 to 50%	Schedule II >50%
Schedule III	Schedule III <10%	Schedule III 10 to 25%	Schedule III 25 to 50%	Schedule III >50%

5. How confident are you in your competency to manage patients with chronic pain and related co-morbidities?

How confident are you in your competency to manage patients with chronic pain and related co-morbidities?   Not at all confident Minimally confident Marginally confident Confident Very confident

6. Have you undergone an ACGME-accredited fellowship in pain and/or palliative care?

Have you undergone an ACGME-accredited fellowship in pain and/or palliative care?   Yes No

7. If no, have you undergone a non-ACGME-accredited pain or palliative care fellowship or training of at least 3 months' duration during your professional education?

If no, have you undergone a non-ACGME-accredited pain or palliative care fellowship or training of at least 3 months' duration during your professional education?   Yes No

8. Please rate your professional training in chronic pain:

Please rate your professional training in chronic pain:   Very poor Poor Good Very good Excellent

9. Do you know what REMS stand for in regard to opioid prescribing?

Do you know what REMS stand for in regard to opioid prescribing?   Yes No Somewhat

10. Are REMS strategies specific to opioids?

Are REMS strategies specific to opioids?   Yes No Unsure

11. Do you feel there is a need among health care professionals with an outpatient office-based practice for a pain mentoring and support program?

Do you feel there is a need among health care professionals with an outpatient office-based practice for a pain mentoring and support program?   Yes No

12. If yes, in your opinion how necessary is this need?

If yes, in your opinion how necessary is this need?   Low Moderate High Very high

13. How enthusiastic would you be in utilizing a comprehensive pain mentoring and support program initiative developed under the auspices of Am J Med?

How enthusiastic would you be in utilizing a comprehensive pain mentoring and support program initiative developed under the auspices of Am J Med?   Not at all Slightly Fairly Highly Very highly

14. Comments:

Comments: