The Smart Medicine Organizer Healthcare Provider Survey
Thank you for participating in this short survey!
On a scale of ONE to SEVEN, how IMPORTANT is it that patients or their caregivers understand the special characteristics of their medicines, including indication, therapy goals, precautions, monitoring parameters, potential side effects, risks and benefits?
1 Extremely UNIMPORTANT
2
3
4
5
6
7 Extremely IMPORTANT
How HELPFUL do you believe the Smart Medicine Organizer would be in facilitating an understanding of the special characteristics of prescribed medicines?
*
1 Extremely UNHELPFUL
2
3
4
5
6
7 Extremely HELPFUL
How HELPFUL do you believe the Smart Medicine Organizer would be in facilitating compliance and helping to prevent accidental omission or duplication of doses?
*
1 Extremely UNHELPFUL
2
3
4
5
6
7 Extremely HELPFUL
How CAPABLE do you believe most patients or caregivers would be in setting up the organizer by themselves, including completion of the pull-out template by hand or electronically, based on information discussed during appointments, pharmacy visits and info that comes with the medicine from the pharmacy, and/or from a trustworthy drug book or website?
*
1 Extremely INCAPABLE
2
3
4
5
6
7 Extremely CAPABLE
What is the LIKELIHOOD you’d work with patients or caregivers directly, whether yourself or staff members, in setting up the organizer and completing the pull-out template?
1 Extremely UNLIKELY
2
3
4
5
6
7 EXTREMELY LIKELY
What is the LIKELIHOOD you’d recommend services from a pharmacist or similarly trained provider, such as CMS approved Medication Therapy Management services that include a comprehensive review of prescribed medicines and any supplements, whereby a patient or caregiver might receive direct supervision for setting up the organizer and completing the pull-out template?
*
1 Extremely UNLIKELY
2
3
4
5
6
7 Extremely LIKELY
How HELPFUL would it be for an electronic service to accompany the organizer so that some parts of the pull-out template may be completed automatically based on a patient’s current therapies, medical guidelines and current FDA safety data, and where screening for potential interactions between medicines, food and any supplements may also occur automatically?
*
1 Extremely UNHELPFUL
2
3
4
5
6
7 Extremely HELPFUL
How HELPFUL would it be for a tablet computer to be used instead of a piece of paper as the pull-out component that slides into the organizer, whereby the pull-out template information may be electronically completed and updated through an internet connection?
*
1 Extremely UNHELPFUL
2
3
4
5
6
7 Extremely HELPFUL
It’s estimated that the cost of the Basic version of the Smart Medicine Organizer will be $54.95 and that the Deluxe version will be $64.95 (neither including a tablet computer). How LIKELY would you be to recommend a version of the Smart Medicine Organizer to those patients or caregivers prescribed or managing five or more medicines?
*
1 Extremely LIKELY
2
3
4
5
6
7 Extremely UNLIKELY
Thank you for taking the time to complete this survey!
Your individual survey responses may be combined with other healthcare provider responses for publication in peer reviewed medical journals. The personal information you provide below will be kept confidential and will not be shared with third parties except those exclusively entrusted with validating the survey results.
Name
*
First Name
Last Name
Profession / Specialty (e.g. family practioner, nurse practioner)
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Phone
-
Area Code
Phone Number
Do you wish to be contacted by Cardinal Support LLC?
*
Yes, I'm interested in a display containing brochures for my practice location(s).
Yes, I'm interested in keeping stock on hand for direct purchase at my practice location(s).
Yes, I'm interested in sponsoring the organizer on a site like Kickstarter.com
No, I’m not interested in the organizer and am only providing my information to establish the validity of any survey results for potential use in peer-reviewed medical journals. Thank you.
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