American Indian/Alaska Native
Access to Specialty Care Survey

Please return your survey in the envelope provided to:

University of Washington, WWAMI Rural Health Research Center, Box 354696, Seattle, WA 98195-4696

page 1

Clinical location (if not correct, please change): ______

(1)Which one of the following best describes your clinical setting? (check only one)

IHS-administered facility
Tribal-compacted facility
(self-governance)
Tribal-contracted facility
(638-contract) / Urban Indian Health Clinic
(Title V program)
Other:
______

(2)Does your facility have the following services on site? (check all that apply)

Outpatient medical care

Inpatient medical care

24-hour emergency room services

(3)In 2000, what was your facility’s yearly number of:

_____ Outpatient visits _____ Inpatient visits

(4)How many of the following primary care providers are currently employed by your clinical site?

_____ General internists_____ Family physicians/general practitioners

_____ Pediatricians_____ Nurse practitioners/physician assistants

_____ Emergency physicians_____ Other (specify:______)

(5)Please list, in order of frequency, the five most common types of physician specialists (e.g., cardiologist) your practice’s patients need to see, and indicate the city or town where you refer patients to these specialists most frequently. Start with 1 as the most frequently needed specialist.

physician specialist type / physician specialist location (city or town)
1. ______/ ______
2. ______/ ______
3. ______/ ______
4. ______/ ______
5. ______/ ______

page 10

If you would like to speak further about this survey or specialty access issues for your patients, please contact Laura-Mae Baldwin, MD, MPH, at206-685-0402 or .

Would you like to receive a copy of the results of this survey?

No Yes Name: ______

Address: ______

______

Please return your survey in the envelope provided to:

University of Washington
WWAMI Rural Health Research Center
Box 354696
Seattle, WA 98195-4696

page 9

(23)What is your gender? Male Female

(24)In what year were you born? ______

(25)What is your main racial group?

African-American
White
Asian / American Indian or Alaska Native
Hawaiian or other Pacific Islander
Other: (specify:______)

(26)Are you of Hispanic/Latino ethnicity? Yes No

(27)How long have you been working at your current clinical facility?

______years, ______months

(28)How long have you been working for the IHS, a tribal health facility, or an urban Indian health facility?

______years, ______months

(29) During a typical week, how many hours do you perform direct patient care?

______hours per week

(30)What percentage of your direct patient care hours do you spend seeing patients in the following settings?

Outpatient clinics ______% Inpatient setting ______% Emergency room ______%

(31) Please feel free to add any further comments about access to specialty care for your patients here.

page 2

(6)Please check all physician specialist types that are available on site at your facility.

Adult Specialists / Pediatric Specialists
visiting / employee / not available / visiting / employee / not available
Medical Subspecialties:
Cardiology
Dermatology
Neurology
Gastroenterology
Rheumatology
Allergy
Pulmonology
Nephrology
Endocrinology
Intensive care
Neonatal intensive care / NA / NA / NA
Surgical Subspecialties:
Orthopedic surgery
Obstetrics/gynecology
General surgery
Ear, nose, and throat
Urology
Ophthalmology
Other:
Psychiatry
______
______

page 3

(7)Think about your experiences referring your patients off site to physician specialists for nonemergent care. How would you rate your patients’ access to the following specialties? (check one for each row)

poor / fair / good / excellent / not applicable
Generalists:
Family & general practice
General internal medicine
Pediatrics
Medical Specialties:
Cardiology
Dermatology
Hematology
Oncology
Neurology
Gastroenterology
Rheumatology
Pulmonology
Nephrology
Endocrinology
Intensive care
Neonatal intensive care
Surgical Specialties:
Orthopedic surgery
Obstetrics/gynecology
General surgery
Ear, nose, & throat
Urology
Ophthalmology
Other:
Psychiatry
______

page 8

(18)List three clinic or provider strategies that have failed to increase access to physician specialty services for your patients.

1. ______

2. ______

3. ______

(19)Which of the following nonphysician provider types are available on site at your facility? (check all that apply and include itinerant services/visiting providers available on site as well as employees of your facility)

Podiatrists
Dentists
Dental hygienists
Chemical dependency counselors / Mental health counselors
(excluding chemical dependency)
Native American traditional healers

(20)In your practice, how restricted do you feel in your ability to obtain the following types of services for your patients when they are clinically indicated? (check one for each row)

not at all restricted / slightly restricted / moderately restricted / extremely restricted
Podiatry
Dental
Dental hygiene
Mental health counseling
Chemical dependency counseling
Native American traditional healers

(21)Which of the following describes your clinical training? (check all that apply)

D.O. M.D. Nurse practitioner Physician assistant

(22)What is your primary specialty? (check one)

Family practice Internal medicine Emergency medicine

General practice Pediatrics Other: (specify:______)

page 7

(11)Overall in your practice, list the three physician specialties that you have had the most difficulty referring to for emergent specialty care:

1. (most difficult)______

2. ______

3. ______

(12)How many patients do you care for each week who should be seen by a physician specialist but are not because of barriers in access tocare?

______patients per week

(13)Thinking about referrals you make to physician specialists, how much of a problem is the pressure to refer children to adult specialists?

No problem Small problem Moderate problem Big problem

(14)Do you have telemedicine capability at your clinical facility?

Yes No (if no, skip to Q17)

(15)How many times per month do you use telemedicine services?

______times per month

(16)Which three physician specialties do you consult with most often via telemedicine?

1. ______

2. ______

3. ______

(17)List three successful clinic or provider strategies that have increased access to physician specialty services for your patients (e.g., contracting with local providers).

1. ______

2. ______

3. ______

page 4

(8)For nonemergent problems, please rate each of the following barriers to your patients’ access to specialtycare. (check one for each row)

no problem / small problem / moderate problem / big problem / not applicable
Lack of insurance
Insufficient contract services budget
Cumbersome specialty referral process
Excessive travel time/distance
Lack of transportation
Excessive wait time to get appointments
Difficulty taking time off work
Patient lack of knowledge on how to use medical system
Specialists’ lack of cultural training or sensitivity
Lag in payment of specialty providers by primary care clinic
Patient lack of follow-through
Specialist unwillingness to take American Indian/Alaska Native patients
Patient ineligibility for contract health services
Patient sense of futility about their health
Patient speaks only tribal language
Other (specify: ______)

page 5

(9)How restricted are you in obtaining nonemergent physician specialty care for the following groups of patients? (check one for each row)

not at all restricted / slightly restricted / moderately restricted / extremely restricted / not applicable
Privately insured patients in general
Medicare-insured patients in general
Medicaid-insured patients in general
Contract service-eligible patients with Medicaid
Contract service-ineligible patients with Medicaid
Patients with no type of insurance in general
Contract service-eligible patients with no type of insurance
Contract service-ineligible patients with no type of insurance

page 6

(10)How would you rate the availability of off-site, informal advice (e.g., telephone consultation) from the following physician specialties? (check one for each row)

poor / fair / good / excellent / not applicable
Generalists:
Family & general practice
General internal medicine
Pediatrics
Medical Specialties:
Cardiology
Dermatology
Neurology
Hematology/oncology
Gastroenterology
Rheumatology
Pulmonology
Nephrology
Endocrinology
Intensive care
Neonatal intensive care
Surgical Specialties:
Orthopedic surgery
Obstetrics/gynecology
General surgery
Ear, nose, & throat
Urology
Ophthalmology
Other:
Psychiatry
Radiology
______