Epocrates QuickSurvey™ Sample
Email Invitation
Survey title/subject / Pre-launch product awareness [survey name]
Standard Screening Questions
1. What is your specialty? [Single Select]
a. Obstetrics/Gynecology[Continue]
b. Other specialty [End Survey]
2. How many years have you been practicing in this specialty? [Numeric Rating, from 0 to 100]
[IF <2 years or >30 years End Survey]
3. Are you board-certified or board-eligible? [Single Select]
a. Yes [Continue]
b. No [End Survey]
4. What percentage of time do you spend seeing patients? [Numeric Rating, from 0 to 100]
[IF <50% End Survey]
Custom Screening Question (Optional, must accept at least 70% of total survey respondents)
Main Survey Questions
5. Which one of the following is your primary concern when deciding on therapy for CONDITION A? [Single Select]
a. Prevention and treatment of CONDITION A
b. Prevention of symptoms associated with CONDITION A
c. Both
6. How much of a factor is FACTOR B when deciding on therapy for CONDITION A? [Single Select]
a. The major factor
b. One of several important factors
c. A minor factor
d. Not at all a factor
7. The results of IMPORTANT STUDY C in 2002 and 2004 presented information which, to a large extent, contradicted acceptable medical practice for treating CONDITION A. Do you find the information from IMPORTANT STUDY C has: [Single Select]
a. Reinforced your established treatment decisions for these patients
b. Caused you to change some of your established treatment decisions for these patients
c. Caused you to change all of your established treatment decisions for these patients
d. Left you unsure of the best practices for treating these patients
8. Which one statement best describes your current opinion/practice as it relates to prescribing MEDICINE D? [Single Select]
a. I use alternatives (MEDICINE E, MEDICINE F, or MEDICINE G) to conventional MEDICINE D, since my focus is prevention/treatment of SYMPTOM H.
b. I no longer recommend/prescribe MEDICINE D for the treatment of SYMPTOM H associated with CONDITION A
c. I prescribe the lowest possible dose of MEDICINE D, both for the treatment of SYMPTOM H and SYMPTOM I
d. I prescribe the lowest possible dose of MEDICINE D for the treatment of SYMPTOM H and alternatives (MEDICINE E, etc..) for the prevention/treatment of SYMPTOM I
e. None of the above
9. Below is a list of statements about RISK FACTOR J. Please rank these statements in order of their importance to you when considering use of MEDICINE D. PLEASE RANK IN DESCENDING ORDER, WHERE 1= MOST IMPORTANT, 2= NEXT MOST IMPORTANT, AND SO ON – EACH STATEMENT MUST HAVE A DIFFERENT NUMBER. [Numeric Rating, from 1to 5] [Numbered Ranking]
a. Breakthrough SYMPTOM H is a barrier to use
b. Good for use in patients at risk of SYMPTOM I
c. Good for use in patients for the prevention/treatment of CONDITION A
d. My treatment of choice for CONDITION A
e. Other (please specify) [One Line Answer]
10. Which one of the following best describes your patients’ awareness of IMPORTANT STUDY C? [Single Select]
a. Most patients are aware of the study results [Continue]
b. Some patients are aware of the study results [Continue]
c. Most patients are unaware of the study results[Skip to Question 12]
11. Which one of the following most closely describes the resulting response of the patients who are aware of the information in IMPORTANT STUDY C? [Single Select]
a. Most patients are still requesting MEDICINE D
b. Some patients still want MEDICINE D; some refuse to consider it
c. Most patients refuse to use MEDICINE D
d. Most patients are unsure of their feelings about MEDICINE D and ask me for a recommendation
12. In your opinion, how much of a concern is each of the following possible effects of MEDICINE D to your patients? PLEASE RANK IN DESCENDING ORDER, WHERE 1= THE ONE OF MOST CONCERN, 2= THE ONE OF NEXT MOST CONCERN, AND SO ON – EACH ITEM MUST HAVE A DIFFERENT NUMBER. [Numeric Rating, from 1 to 5] [Numbered Ranking]
a. SIDE EFFECT J
b. SIDE EFFECT K
c. SIDE EFFECT L
d. SIDE EFFECT M
13. Have you ever heard of the drug INVESTIGATIONAL COMPOUND N? [Single Select]
a. Yes[Continue]
b. No [End Survey]
14. What one statement best describes your understanding of what INVESTIGATIONAL COMPOUND N is? [Single Select]
a. A compound to treat CONDITION A
b. A compound that is a better alternative to conventional MEDICINE D
c. A compound similar to conventional MEDICINE D
15. Which of the following are information sources you used to learn about INVESTIGATIONAL COMPOUND N? Choose all that apply. [Multi Select]
a. Studies from countries outside the U.S.
b. Studies conducted in the U.S.
c. Presentations/material at medical meetings
d. Peers/colleagues
e. Key SPECIALTY O opinion leaders
f. Other (please specify) [Single Line Answer]
16. Which of the following best represents your understanding of INVESTIGATIONAL COMPOUND N's relationship to CONDITION A?
a. INVESTIGATIONAL COMPOUND N decreases the risk for developing SIDE EFFECT J
b. INVESTIGATIONAL COMPOUND N increases the risk for developing SIDE EFFECT J
c. INVESTIGATIONAL COMPOUND N has no relationship to SIDE EFFECT J
17. On what do you base your understanding of INVESTIGATIONAL COMPOUND N’s relationship to CONDITION A? Choose all that apply. [Multi Select]
a. Studies from countries outside the U.S.
b. Studies conducted in the U.S.
c. Presentations/material at medical meetings
d. Knowledge of INVESTIGATIONAL COMPOUND N'S mechanism of action
e. Peers/colleagues
f. Key SPECIALTY O opinion leaders
g. Other (please specify) [Single Line Answer]
18. Which of the following best represents your understanding of INVESTIGATIONAL COMPOUND N'S relationship to CONDITION P? [Single Select]
a. INVESTIGATIONAL COMPOUND N decreases the risk for developing SIDE EFFECT J
b. INVESTIGATIONAL COMPOUND N increases the risk for developing SIDE EFFECT J
c. INVESTIGATIONAL COMPOUND N has no relationship to SIDE EFFECT J
19. On what do you base your understanding of INVESTIGATIONAL COMPOUND N's relationship to CONDITION P? Choose all that apply. [Multi Select]
a. Studies from countries outside the U.S.
b. Studies conducted in the U.S.
c. Presentations/material at medical meetings
d. Knowledge of INVESTIGATIONAL COMPOUND N's mechanism of action
e. Peers/colleagues
f. Key SPECIALTY O opinion leaders
g. Other (please specify) [Single Line Answer]
20. Assume there has been a 30% decrease in HDL reported with the use of INVESTIGATIONAL COMPOUND N. How much of a barrier will that be to prescribing INVESTIGATIONAL COMPOUND N for your CONDITION A patients at risk for SYMPTOM H? [Single Select]
a. A complete barrier, I would not prescribe for at-risk patients
b. Somewhat of a barrier, it depends on the individual patient’s risk profile
c. A minor barrier, it might not be appropriate for some at-risk patients
d. Not at all a barrier, this would not deter me from prescribing for at-risk patients
e. Don’t know
Last Updated 8/30/05Page 1 of 4