People Living With Diabetes: Questionnaire on Access to Medicines
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People Living With Diabetes: Questionnaire on Access to Medicines and Medical Devices The International Diabetes Federation Europe has created this questionnaire as part of it's publication "Access to Quality Medicines and Medical Devices for diabetes care in Europe". The nine month study has the objective to assess whether people living with diabetes (PLD) across the European region have equal access to high quality/ innovative diabetes medicines and medical devices. Due to the limitations of this project, the survey is not comprehensive and will only provide a snapshot regarding a selected number of essential product types in the treatment of diabetes. Please be advised: This questionnaire has been made to be answered by PLD or a relative. The questionnaire should take no longer than 10-15 minutes to complete. We will ask you about the details and prices of the products you use in your treatment of diabetes, so please have this available before you start the questionnaire. This questionnaire is anonymous and all data collected will be treated with the strictest confidence. Individual data will not be given to anyone outside IDF Europe. This Questionnaire should be completed by 17 May 2013 at the latest. Please send scanned / electronically completed by email or printed + faxed to Stefan Callan (stefan.callan@idf-europe.org – FAX +32 2 5371981, attention of Stefan Callan). This Questionnaire is also available online @ https://www.surveymonkey.com/s/Z87H35Z By completing this questionnaire, you acknowledge: that you have understood the conditions and purpose of the Questionnaire are willing to allow the data to be used in aforementioned publication. you have not received any compensation for completing this survey. Basic Information 1. Are you: ☐A person living with diabetes (PLD) ? ☐Completing this survey on behalf of a PLD? 2. What type of diabetes do you have? ☐Type 1 Diabetes ☐Type 2 Diabetes ☐Gestational Diabetes ☐Other ☐I don't know 3. Which country do you live in? Choose an item. 4. Do you live in your country's capital city? ☐Yes ☐No 5. How far away do you live from a practicing doctor and/or pharmacist? ☐5km or more ☐Less than 5km 6. Where do you get your diabetes MEDICINES from? ☐public hospital ☐public primary healthcare center ☐ public pharmacy ☐private hospital ☐private clinic or primary healthcare center ☐ private pharmacy ☐patient organsiation ☐other NGO ☐other (please specify)………………………… 7. Where do you get your diabetes MEDICAL DEVICES from? ☐public hospital ☐public primary healthcare center ☐ public pharmacy ☐private hospital ☐private clinic or primary healthcare center ☐ private pharmacy ☐patient organsiation ☐NGO ☐Other (please specify) ………………………… 8. How long does it take for you to get to your MEDICINES? ☐Less than 30 minutes ☐Between 30 minutes and 1 hour ☐Between 1 hour and 6 hours ☐Over 6 hours 9. How long does it take for you to get to your MEDICAL DEVICES? ☐Less than 30 minutes ☐Between 30 minutes and 1 hour ☐Between 1 hour and 6 hours ☐Over 6 hours General access to Products 10. To your knowledge, which of the following product types can be obtained PLD in your local area ? ☐Human insulin (Vial or Cartridge of Regular/Short­acting insulin; NPH/Intermediate/Medium­acting insulin; Premixed) ☐Insulin Analogs (Vial or Cartridge of Long­acting; Rapid­acting; Premixed) ☐Hypoglycemia medication (glucagon & glucose tablets) ☐Metformin ☐DPP­4 inhibitors (Vildagliptin; Sitagliptin; Saxagliptin; Linagliptin) ☐Other oral or injectable medicines ☐Syringes and Needles ☐Insulin pens and Supplies (Needles, Canula...) ☐Conventional Insulin pumps and supplies (Tubing; Infusion set; Battery...) ☐Blood Glucose test strips ☐Ketone test strips (either urine or blood test strips) ☐Blood Glucose meters ☐I don't know 11. Which of the following product types do you use and/or has your doctor (practitioner) advised you to use in the treatment of your diabetes? ☐Human insulin (Vial or Cartridge of Regular/Short­acting insulin; NPH/Intermediate/Medium­acting insulin; Premixed) ☐Insulin Analogs (Vial or Cartridge of Long­acting; Rapid­acting; Premixed) ☐Hypoglycemia medication (glucagon & glucose tablets) ☐Metformin ☐DPP­4 inhibitors (Vildagliptin; Sitagliptin; Saxagliptin; Linagliptin) ☐Other oral or injectable medicines ☐Syringes and Needles ☐Insulin pens and Supplies (Needles, Canula...) ☐Conventional Insulin pumps and supplies (Tubing; Infusion set; Battery...) ☐Blood Glucose test strips ☐Ketone test strips (either urine or blood test strips) ☐Blood Glucose meters ☐I don't know Disclaimer From this point onwards, you will be asked various single / multiple choice questions regarding the medicines and medical devices you use in the treatment of your diabetes. Please be aware that ALL product categories highlighted in the previous question will be displayed in the remainder of the survey. If you DON'T USE (or DON'T KNOW if you use) a product / products, please do not complete the relevant rows / columns associated with that product/s in any of the remaining questions. Medicines and Medical Products You Use 12. For the products you use and/or your doctor (practitioner) has advised you to use, have you received any training or education on how to use them? Human insulin Insulin Analogs Hypoglycemia medication Metformin DPP-4 inhibitors Other oral or injectable medicines Syringes and Needles Insulin pens and Supplies Conventional Insulin pumps and supplies Blood glucose test strips Ketone test strips Blood Glucose meters I have received training/education on how to use this product in the treatment of my diabetes ☐ ☐ ☐ ☐ ☐ ☐ One or more of my relatives have received such training/education ☐ ☐ ☐ ☐ ☐ ☐ I have access to information on how to use this product from the MANUFACTURER ☐ ☐ ☐ ☐ ☐ ☐ I have not received any training or education to use these products ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ 13. For the products you use and/or your doctor (practitioner) has advised you to use, have you had problems getting these products in the past: ☐Month? ☐6 months? ☐Year? ☐2 years? ☐I did not have a problem obtaining my diabetes products (if so, please skip to question 18) Problems obtaining diabetes medicines 14. As you answered that you have had problems accessing diabetes products, please state which products you were unable to obtain? ☐Human insulin ☐Insulin Analogs ☐Hypoglycemia medication ☐Metformin ☐DPP-4 inhibitors ☐Other oral or injectable medicines ☐Syringes and/or Needles ☐Insulin pens and/or Supplies ☐Conventional Insulin pumps and / or supplies ☐Blood Glucose test strips ☐Ketone test strips ☐Blood Glucose meters 15. To your knowledge, what caused difficulties to obtain these products? Please choose the frequency of the problem/s you faced It rarely happened It usually happened It always happened ☐ ☐ ☐ This is not applicable to me ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ The product/s was sold out / not in stock at my local outlet I was unable to go to the delivery point (where the product/s is given or sold) The price increased and I couldn't afford the product Reimbursement levels decreased and I couldn't afford the product I had financial problems and I couldn't afford the product 16. When faced with these problems, what did you do? ☐I went to another delivery point ☐I went to my patient association ☐I remained without the product I needed until the problem was resolved 17. When these difficulties occurred, how long did you remain without yourmedicine/medical device? ☐< 2 days ☐Between 2 days and 1 week ☐Between 1 and 2 weeks ☐Between 2 week and 1 month ☐> 1 month Classification of products 18. Do you use generic and/or branded products? Please leave any irrelevant choices blank If you are unsure which category the products you are using falls under, please skip this question Human Insulin Hypoglycemia Metformin DPP-4 Oral or Syringes Insulin Analog medication inhibitors injectable and medicines Needles Branded Generic ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Insulin Insulin Blood Ketone pens pumps glucose test and and test strips Supplies supplies strips ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Blood Glucose meters ☐ ☐ 19. Why do you use generic or branded products? Human Insulin Hypoglycemia Metformin DPP-4 Oral or Syringes Insulin Analog medication inhibitors injectable and medicines Needles It's the only product available It was determined by my healthcare provider My doctor recommended it It is cheaper than its competitors It is of higher quality than its competitors It works better for me than its competitors It is reimbursed / provided for free Insulin Insulin Blood pens pumps glucose and and test Supplies supplies strips ☐ ☐ ☐ Ketone test strips Blood Glucose meters ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Illegally Available Products *** Please note, this questionnaire is anonymous and completely confidential - Your honest answer is much appreciated to provide accurate data in this survey*** 20. To your knowledge, do you know of people that buy their medicines and medical devices for their diabetes treatment illegally on the black market? ☐Yes ☐No Price Cap of Products 21. Is there a maximum price for the diabetes products you use? ☐Yes ☐No ☐I don’t know 22. Is there a maximum reimbursement rate for the diabetes products you use? ☐Yes ☐No ☐I don’t know Product Details and Prices You will now be asked to provide prices and other details for a selection of products. Please enter details of the specific products you use under each category type. If you use two different brands for the same product, please only report below the details for the brand you use most. Prices should be given in national currency, minus potential reimbursements you'd receive after the purchase. If you do not pay anything for a product you use, please write 0 in the price box. Please leave blank the product categories you do not use. 23. Details and Price for Human NPH Insulin; U100; 10mL vial Commercial Name Manufacturer Price / vial Click here to enter text. Click here to enter text. Click here to enter text. 24. Details and Prices for Metformin; 500mg; 1 Tablet Commercial Name Manufacturer Price / Tablet Click here to enter text. Click here to enter text. Click here to enter text. 25. Details and Prices for Sitagliptin; 100mg; 1 Tablet Commercial Name Manufacturer Price / Tablet Click here to enter text. Click here to enter text. Click here to enter text. 26. Details and Prices Insulin pen; 1 reusable device for a max. dosage of 60 units Commercial Name Manufacturer Price / device Click here to enter text. Click here to enter text. 27. Details and Prices for 1 conventional insulin pump Commercial Name Manufacturer Price / device Click here to enter text. Click here to enter text. Click here to enter text. 28. Details and Prices for Blood glucose test strips; 1 box of 50 strips Commercial Name Manufacturer Price / box Click here to enter text. Click here to enter text. Click here to enter text. Payment and Reimbursement of Products 29. Complete the following table for the products that you use and according to your own experience. Please only fill boxes that apply to you and leave the others blank Insulin (any) I get this product for FREE I get this product at a SUBSIDISED price This product is FULLY REIMBURSED to me This product is PARTIALLY REIMBURSED to me This product is NOT REIMBURSED or NOT provided for FREE Hypoglycemia medication Oral or injectable medicines (including Metformin & DPP-4 inhibitors) Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Syringes and Needles Insulin Pens and Supplies Insulin pumps & supplies Blood glucose test strips Blood Glucose meters Ketone test strips Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Payment of Products 30. For products that are provided for free, subsidised or reimbursed, who pays: ☐Central government or local state budget ☐National Health Insurance system ☐Compulsory private insurance ☐Voluntary private insurance ☐NGO ☐Other ☐I don't know 31. As an estimate, how much do you personally pay for your diabetes medicines and medical devices per month? (Amount after any reimbursement, in national currency) (If your medicines / medical products are for FREE, insert "0"below) ………………………………………………..
