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Data Collection Survey
1.
What is your position?
Pharmacist
Technician
Student Pharmacist
Other
2.
What is your primary practice setting?
Community or retail
Ambulatory or outpatient clinic
Inpatient or hospital
Other
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)
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
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
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
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
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
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
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
11.
Please provide details on why this activity/CE will/will not increase your ability to provide medication management services.