services you received from your specialist(s) in the Satisfied 2 past 12 months? Neither satisfied or 3 dissatisfied Dissatisfied 4 Very dissatisfied 5 know 888 Don’t Generalist AUD Care How many visits did you make in the past 12 AUDGVISIT B24 ___ visits months to the generalists named above? How many minutes did these visits last on AUDGMINS B25 ___ minutes average? Medication 1 AUDGTX AUDGTXO Counselling 2 What was the nature of the treatment provided by B26 [go to B28] the generalist(s)? Other [specify] 77 [go to B28] _____ 1. weeks AUDGRX1 What is the name and daily dosage of the _____ 2. medication(s) provided by the generalist(s) named weeks AUDGRX2 B27 above? How long were you taking this _____ medication? 3. weeks AUDGRX3 4. know 888 Don’t No 0 AUDGDONE Did you complete the full recommended course of B28 Yes 1 treatment? know 888 Don’t No 0 AUDGSTOP B29 Are you still seeing a generalist? Yes 1 A lot 1 AUDGHELP B30 How much has the treatment helped you? Some 2
services you received from your specialist(s) in the past 12 months? Satisfied 2 Neither satisfied or dissatisfied 3 Dissatisfied 4 Very dissatisfied 5 Don’t know 888 Generalist AUD Care B24 How many visits did you make in the past 12 months to the generalists named above? ___ visits AUDGVISIT B25 How many minutes did these visits last on average? ___ minutes AUDGMINS B26 What was the nature of the treatment provided by the generalist(s)? Medication 1 AUDGTX AUDGTXO Counselling [go to B28] 2 Other [specify] [go to B28] 77 B27 What is the name and daily dosage of the medication(s) provided by the generalist(s) named above? How long were you taking this medication? 1. _____ weeks AUDGRX1 AUDGRX2 AUDGRX3 2. _____ weeks 3. _____ weeks 4. Don’t know 888 B28 Did you complete the full recommended course of treatment? No 0 AUDGDONE Yes 1 Don’t know 888 B29 Are you still seeing a generalist? No 0 AUDGSTOP Yes 1 B30 How much has the treatment helped you? A lot 1 AUDGHELP Some 2
PRIME%20Community%20Survey%20Questionnaire_FINAL.docx