2017 WPQC Medication Therapy Management Workgroup Interest Survey

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* 1. Name

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* 2. Email Address

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* 3. Pharmacy Name

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* 4. Are you interested in being part of the WPQC Medication Therapy Management (MTM) Workgroup Series?

Yes

Yes, but not at this time

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* 5. Have you participated in the WPQC Medication Therapy Management (MTM) Workgroup Series before?

Yes

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* 6. The WPQC MTM Workgroup Series will be held every other week via phone to discuss helpful tips, barriers, and solutions. Which time slot is best for an every other week phone call, beginning March 15th?

Wednesdays, 8 AM

Thursdays, 2 PM

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* 7. Check all that apply to your current work environment as it relates to WPQC:

Utilize Paid Interns

Precept Clerkship Students

Significant Medicaid Population

Location: Rural

Location: Suburban

Location: Urban

Average Patient Age: >64 years old

Average Patient Age: 40 - 64 years old

Average Patient Age: <40 years old

Fill <100 prescriptions per day/pharmacist

Fill >100 prescriptions per day/pharmacist

Motivated MTM staff

Other (please specify)

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* 8. What are your current barriers to implementation of WPQC?

Time

Staffing

Workflow

Patient Interest

Patient "no-shows"

Prescriber responsiveness to recommendations

Prescriber Marketing

Confidence providing MTM Services

Other Company Priorities

Other (please specify)

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* 9. How would you characterize your MTM/WPQC involvement at the current time?

Advanced (Provide >50 CMR/A Services monthly)

Intermediate (Provide 10 - 50 CMR/A Services monthly)

Low (Provide <10 CMR/A Services monthly)

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* 1. Name

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* 2. Email Address

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* 3. Pharmacy Name

Question Title

* 4. Are you interested in being part of the WPQC Medication Therapy Management (MTM) Workgroup Series?

Question Title

* 5. Have you participated in the WPQC Medication Therapy Management (MTM) Workgroup Series before?

Question Title

* 6. The WPQC MTM Workgroup Series will be held every other week via phone to discuss helpful tips, barriers, and solutions. Which time slot is best for an every other week phone call, beginning March 15th?

Question Title

* 7. Check all that apply to your current work environment as it relates to WPQC:

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* 8. What are your current barriers to implementation of WPQC?

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* 9. How would you characterize your MTM/WPQC involvement at the current time?

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* 10. What do you hope to achieve from participating in a WPQC MTM Workgroup Series?