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MINT-ACITRETIN (acitretin) 10 mg and 25 mg Capsules
Mint-Acitretin Voluntary Survey
1.
Have you done this survey before?
Yes
No
2.
Are you a:
Dermatologist/Specialist
Family Physician/General Practitioner
Pharmacist
Patient
Other (please specify)
3.
Have you visited the MINT-ACITRETIN Pregnancy Prevention Program website in the past?
Yes
No
4.
When visiting this website or program, what is the usual purpose of your visit? (check all applicable answers)
Get information about psoriasis
Get information about MINT-ACITRETIN
Download Pregnancy Prevention Program booklet
Download Patient Information/ Consent Form
5.
For physicians, when you prescribe MINT-ACITRETIN, how often do you comply with various components of the MINT-ACITRETIN Pregnancy Prevention Program?
Always
As often as necessary
I’d rather not say
Pregnancy Prevention Program booklet
Always
As often as necessary
I’d rather not say
Pregnancy Prevention Checklist
Always
As often as necessary
I’d rather not say
Patient Consent Form
Always
As often as necessary
I’d rather not say
6.
Which feature(s) of the program, if any, act as a barrier to its optimal implementation? (check all applicable answers)
None, the program meets my needs and/or those of my patients
Clarity of acitretin prescribing responsibilities
Time required to comply
Presentation format of materials
Testing requirements for compliance
Have not used the program enough to comment
Difficulty in accessing forms and other information
Other (please specify)
7.
In your opinion, is there a need for more educational materials than what is currently available to help you in prescribing/dispensing acitretin products?
Yes
No
If yes, please list topic(s) that will be helpful to you:
Current Progress,
0 of 7 answered
