Submitted by Jeffrey Lake on Wed, 02/17/2016 - 4:30pm Country of Residence: * Are you a: * general practitioner/family medicine doctor/internist respiratory physician/pulmonary specialist/chest medicine specialist Other... Are you a: Other... Describe your practice Private practice Public/hospital practice How long have you been in practice? <5 years 5–10 years 11–15 years >16 years I. COPDA. Familiarity with condition and guidelinesPlease answer the following questions by ticking one circle (o) in each line, on a scale of 1–5: 1 being not at all familiar and 5 extremely familiar. 1.In general, how would you rate your familiarity with the condition of chronic obstructive pulmonary disease (COPD)? 1 2 3 4 5 2.How familiar are you with the content of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines? 1 2 3 4 5 3.Does your country have its own local COPD guidelines, that is, guidelines produced by organisations, institutions, or the Ministry/Department of Health? Yes No I do not know 4.How familiar are you with the content of your local guidelines pertaining to COPD diagnosis and management? 1 2 3 4 5 B.Confidence in diagnosing and treating COPD, and monitoring and educating patientsPlease answer the following questions by ticking one circle (o) in each line, on a scale of 1–5: 1 being not at all confident and 5 extremely confident. 1. Diagnosing COPD a.How confident are you in diagnosing COPD based on the GOLD criteria? 1 2 3 4 5 b.How confident are you in diagnosing COPD based on your local guidelines? 1 2 3 4 5 2. Treatment Options a.How confident are you in choosing treatment for COPD based on the GOLD criteria? 1 2 3 4 5 b.How confident are you in choosing treatment for COPD based on your local guidelines? 1 2 3 4 5 3.How confident are you in monitoring patients with COPD to ensure that patients adhere to treatment and that goals are met? 1 2 3 4 5 4.How confident are you in educating your patients about COPD? 1 2 3 4 5 5.How confident are you in educating your patients’close family members or carers about COPD? 1 2 3 4 5 C. On average, how many patients with symptoms of COPD consult with you in a month? 0–1 2–5 6–10 11–15 >15 II. AsthmaA. Familiarity with condition and guidelinesPlease answer the following questions by ticking one circle (o) in each line, on a scale of 1–5: 1 being not at all familiar and 5 extremely familiar. 1.In general, how would you rate your familiarity with the condition of asthma? 1 2 3 4 5 2.How familiar are you with the content of the Global Initiative for Asthma (GINA) guidelines? 1 2 3 4 5 3.Does your country have its own local asthma guidelines? Yes No I do not know 4.How familiar are you with the content of your local guidelines pertaining to asthma diagnosis and management? 1 2 3 4 5 B.Confidence in diagnosing and treating asthma and monitoring and educating patientsPlease answer the following questions by ticking one circle (o) in each line, on a scale of 1–5: 1 being not at all confident and 5 extremely confident. 1. Diagnosing asthma a.How confident are you in diagnosing asthma based on the GINA criteria? 1 2 3 4 5 b.How confident are you in diagnosing asthma based on your local guidelines? 1 2 3 4 5 2. Treatment Options a.How confident are you in choosing treatment for asthma based on the GINA criteria? 1 2 3 4 5 b.How confident are you in choosing treatment for asthma based on your local guidelines? 1 2 3 4 5 3.How confident are you in monitoring patients with asthma to ensure that patients adhere to treatment and that goals are met? 1 2 3 4 5 4.How confident are you in educating your patients about asthma? 1 2 3 4 5 5.How confident are you in educating your patients’ close family members or carers about asthma? 1 2 3 4 5 C. On average, how many patients with asthma symptoms consult with you in a month? 0–1 2–5 6–10 11–15 >15 III. Asthma–COPD overlap syndrome (ACOS) A. Are you aware of the condition called asthma–COPD overlap syndrome or ACOS? Yes No B. 1. Have you encountered patients with ACOS? Yes No B. 2. On average, how many patients with ACOS consult with you in a year? 0–1 2–5 6–10 11–15 >15 C. Are you aware of the GOLD-GINA guidelines "Diagnosis of diseases of chronic airflow limitation: asthma, COPD, and Asthma-COPD overlap syndrome (ACOS)"? Yes No D.Familiarity with ACOS and GOLD–GINA guidelinesPlease answer the following questions by ticking one circle (o) in each line, on a scale of 1–5: 1 being not at all familiar and 5 extremely familiar. 1.In general, how would you rate your familiarity with the condition of ACOS? 1 2 3 4 5 2.How familiar are you with the content of the GOLD-GINA guidelines on ACOS? 1 2 3 4 5 3.Does your country have its own local guidelines on ACOS? Yes No I do not know 4.How familiar are you with the content of your local guidelines pertaining to ACOS diagnosis and management? 1 2 3 4 5 E. Confidence in diagnosing ACOS and managing Please answer the following questions by ticking one circle (o) in each line, on a scale of 1–5: 1 being not at all confident and 5 extremely confident. 1.How confident are you in diagnosing ACOS? 1 2 3 4 5 2.How confident are you in managing patients with ACOS? 1 2 3 4 5 IV.Shared decision making and healthcare provider education A.Are you aware of the consultation process called "shared decision making"? Yes No B.How likely are you to use the shared decision making process when managing patients with asthma, COPD or ACOS? Please answer the following questions by ticking one circle (o) in each line, on a scale of 1–5: 1 being extremely unlikely and 5 extremely likely. 1 2 3 4 5 Why are you extremely unlikely or unlikely to use the shared decision making process when managing patients with asthma or COPD? C.Likelihood of participating in a workshopPlease answer the following questions by ticking one box () in each line, on a scale of 1–5: 1 being extremely unlikely and 5 extremely likely. 1.How likely are you to participate in an educational workshop that provided educational strategies to identify and help overcome barriers to treatment and potentially assist adherence in patients with asthma or COPD? 1 2 3 4 5 2. How likely are you to participate in an educational workshop where you can learn about the process of shared decision making? 1 2 3 4 5 Leave this field blank
