LUN2827: Schizophrenia Treatment Landscape - Questionnaire
July 2012
Contact:
Cassie Partington cassie.partington@informed-insight.com
tel: +44 (0)1625 509287
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
Comments:
- Only black font is shown to respondents
- Red is for information
- Blue is programmer notes (PN)
[PN: All questions should be on separate screens, unless indicated otherwise.]
CONTENTS
SCREENER ................................................................................................................................................ 7
S1 Specialty ......................................................................................................................................... 7
S1a [ASK Nervenärtzes ONLY:] ............................................................................................................ 7
S2 Number of years since qualifying ................................................................................................... 8
S3 Caseload ......................................................................................................................................... 8
S4 Initiate treatment ........................................................................................................................... 8
S5 Initiate depot treatment ................................................................................................................ 8
S6 Country regions .............................................................................................................................. 9
S7 Setting .......................................................................................................................................... 10
SECTION A: PHYSICIAN QUESTIONNAIRE .............................................................................................. 12
A1 Setting .......................................................................................................................................... 14
A2 Estimated prescribing .................................................................................................................. 15
A3 Unmet needs ............................................................................................................................... 17
A4 Level of adherence among physician’s patients .......................................................................... 19
A5 Establishing a patient’s level of adherence to treatment regimen ............................................. 19
A6 Reason for non-adherence .......................................................................................................... 20
A7 Improving adherence ................................................................................................................... 21
A8 Knowledge of poor insight into disease ...................................................................................... 22
A9 Establishing level of insight in patients with schizophrenia ........................................................ 22
A10 Prevalence of poor insight among physicians’ patients ............................................................ 23
A11 Improvement of insight into disease ......................................................................................... 23
A12 Impact of poor insight on patient’s prognosis ........................................................................... 24
A13a Impact of level of insight on treatment decision ..................................................................... 25
A13b Specific impact on depot ......................................................................................................... 25
SECTION B: PATIENT RECORD FORM .................................................................................................... 27
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B0 Date of most recent consultation ................................................................................................ 28
B1 Date of birth ................................................................................................................................. 28
B2 Gender ......................................................................................................................................... 28
B3 BMI ............................................................................................................................................... 29
B4 Employment status ..................................................................................................................... 30
B5 Family status ................................................................................................................................ 31
B6a Reason for most recent consultation......................................................................................... 32
B6b Action from consultation ........................................................................................................... 32
B7a Date of diagnosis ....................................................................................................................... 33
B7b Number of years in psychiatrists care ....................................................................................... 33
B8a Number of consultations with patient ....................................................................................... 33
B8b Number of relapses ................................................................................................................... 33
B9 Patient journey ............................................................................................................................ 34
B10a Settings versus disease stages ................................................................................................. 35
Hospital (chronic/long-term care) .................................................................................................... 35
B10b Healthcare professionals ......................................................................................................... 36
B11 Disease severity (CGI) ................................................................................................................ 37
B12a Current status (option 1) ......................................................................................................... 38
B12b Current status (option 2) ......................................................................................................... 38
B13 Status scale preference .............................................................................................................. 39
B14 Quality of life.............................................................................................................................. 40
B15 Patient’s level of insight ............................................................................................................. 40
B16a Patient circumstances .............................................................................................................. 41
B16b Patient circumstances: drug / alcohol ..................................................................................... 41
B17 Hospitalisation ........................................................................................................................... 42
B18 Number of times hospitalised .................................................................................................... 42
B19 Duration of hospital stay............................................................................................................ 42
B20 Treatment change at discharge from hospital .......................................................................... 43
B21a Treatment at discharge from hospital ..................................................................................... 43
B21b Discharged on a depot formulation ......................................................................................... 44
B22 Current treatments .................................................................................................................... 45
B23 Side effects ................................................................................................................................. 47
B24 Current treatment information ................................................................................................. 48
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B24b. Dose change ............................................................................................................................ 49
B25 Previous treatment before depot .............................................................................................. 50
B26 Reason prescribed a depot treatment ....................................................................................... 50
B27 First prescription of a depot treatment ..................................................................................... 51
B28 Reason not currently on a depot treatment .............................................................................. 52
B29 Current symptoms ..................................................................................................................... 53
B30 Severity of symptoms ................................................................................................................ 54
B31 Patient awareness of symptoms ................................................................................................ 54
B32 Symptom perception in relation to medication ........................................................................ 55
B33 Reasons for prescribing ............................................................................................................. 56
B34 Anticipated future non-adherence ............................................................................................ 58
B35 Previous treatment .................................................................................................................... 59
B36 Previous treatment information ................................................................................................ 61
B36b. Dose change ............................................................................................................................ 62
B37 Reasons for discontinuing / switching treatment ...................................................................... 63
B40 Numbers of patients that are anticipated non-compliant ......................................................... 65
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
SCREENER
S0 Language
Please select
1. Complete survey in English
2.
Complete survey in Portuguese
3.
Complete survey in French
4.
Complete survey in Danish
5.
Complete survey in Finnish
7.
Complete survey in German
8.
Complete survey in Italian
9.
Complete survey in Norwegian
10.
Complete survey in Polish
11.
Complete survey in Spanish
12.
Complete survey in Swedish
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
S0 Country
In which country is your practice located?
1. Australia
2.
Brazil
COUNTRY CODE
AU
BR
3.
Canada
4.
Denmark
5.
Finland
6.
France
7.
Germany
8.
Italy
9.
Norway
CA
DK
FI
FR
DE
IT
NO
10.
Poland
11.
Spain
PL
ES
12.
Sweden
13.
UK
SW
UK
99.
Other [CLOSE]
[PN: SINGLE CODE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
SCREENER (2 minutes)
Thank you for your interest in our market research survey on the treatment of patients with schizophrenia. As with any survey, there are certain criteria that must be met in order to participate.
If you qualify for the survey you will be asked to provide information from the charts or medical records for 6 adult patients diagnosed with schizophrenia. Nothing that can identify individual patients will be asked.
The following screening questions should take no more than 2-3 minutes.
Please click ‘Forward’ to continue.
S1 Specialty
What is your primary medical specialty?
1. Primary care physician [UK SHOW:] General practitioner
2. Psychiatrist
3. Nervenärtze [SHOW IN GERMANY ONLY]
99. Other
CLOSE
CONTINUE TO S2
CLOSE
CONTINUE TO S1a
[QUOTA FOR DE SET TO 70/30 for Psychiatrist and Nervenartze]
[PN: SAME SCREEN]
S1a [ASK Nervenärtzes ONLY:]
What proportion of your time in practice do you spend working in psychiatry?
___%
[MUST SPEND AT LEAST 30%, OTHERWISE SCREEN OUT]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
S2 Number of years since qualifying
How many years have you been practicing in your clinical specialty, after qualifying?
____ years
[Terminate if < 2 or > 40]
[PN: allow range 0-90]
S3 Caseload a.
Thinking about an average month, approximately how many patients do you see in
total? ________ patients b.
Of these, how many patients with schizophrenia do you personally treat or manage in a month? ________ patients
[Terminate if fewer than 10 patients (S3b)]
[PN: Allow range 0 – 999].
S4 Initiate treatment
Do you initiate or change drug treatment for patients with schizophrenia?
1. Yes CONTINUE
2. No CLOSE
PN: in Nordics show “initiate / prescribe” in place of just initiate.
S5 Initiate depot treatment
Do you initiate depot treatment for patients with schizophrenia?
1. Yes CONTINUE
2. No CONTINUE
PN: in Nordics show “initiate / prescribe” in place of just initiate.
SET MAX OF 50% WHO CANNOT ADMINISTER DEPOTS
MONITOR DURING FIELDWORK TO ENSURE SAMPLE INCLUDES ENOUGH PSY PRESCRIBING
DEPOTS (NEED AS HIGH A NUMBER AS POSSIBLE PER MARKET – AT LEAST HALF PER MARKET
INITIATING DEPOT)
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
ANALYSIS TO BE COMPLETED BY ORAL/DEPOT AND BY PATIENT FLOW MODEL (INDIVIDUAL
COUNTRY LEVEL)
S6 Country regions
Which of the following regions [PN: In CA –show ‘provinces’ not ‘regions’, in AU show ‘states’] do you primarily work in?
[SEE REGIONS ON EXCEL SHEET]
MONITOR DURING FIELDWORK AND ENSURE SAMPLE IS REPRESENTATIVE OF MARKET
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
S7 Setting
Approximately what percentage of your time spent in direct patient care is in each of the following health care locations?
Type in % for each
FR DE ES IT UK CA BR AU PL NORDICS
1 Hospital (acute care)
2 Hospital (chronic / long-term care)
3 Day hospital (intermediary care)
4 Outpatient clinic
(CMP)
5 Private practice
Ambulatory
Service
Centro de
Salud
Mental
Community
Mental
Health
Center
Outpatient clinic
Out-patient clinic n/a
Out-patient clinic / community care n/a n/a n/a Private practice n/a
6 Private hospital n/a n/a
7 Judicial/forensic setting (prison)
8 n/a n/a Private hospital n/a
Psychiatric clinic n/a
9 n/a
99 Other, please specify
Total: MUST SUM TO 100%
GP/ PCP clinic n/a
[PN: if sum of code 5 and code 6 (private practice and private hospital) are over 50% for UK, screen out]
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
MONITOR DURING FIELDWORK AND ENSURE SAMPLE IS REPRESENTATIVE OF MARKET
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
SECTION A: PHYSICIAN QUESTIONNAIRE (8 minutes)
INTRODUCTION TO MARKET RESEARCH STUDY
You are invited to take part in this market research study, the purpose of which is to better understand the treatment of schizophrenia by focusing on individual patients.
This study is being conducted by an independent market research agency for scientific purposes, and has no promotional intent. This research is being sponsored by a global pharmaceutical company.
Your responses will be kept completely confidential and anonymous in line with market research codes of conduct and data protection laws, and will be analysed along with a large number of other physicians across several countries.
We would like you to provide information from the medical records of 6 adult patients
diagnosed with schizophrenia that you are currently managing (randomly selected based on instructions that will be provided).
For each patient we would like you to fill in a patient profile that will take approximately 16-18 minutes to complete. You should use patient medical records to ensure that the information you provide is accurate.
Please note that no personal identifying information about any patient will be asked. In line with the Data Protection Directive 95/46/EC, all relevant data will be kept strictly confidential and anonymous. This study is also compliant with the EphMRA and ABPI
Codes of Conduct.
Important note: In order to achieve a random sample of patients, we need your cooperation in following the selection criteria outlined CAREFULLY
without your cooperation, it is unlikely that our resulting sample will be truly representative of the universe of treated patients (if you select patients based on recall alone, it is likely the resulting sample will be skewed toward atypical cases
difficult or atypical cases being easier to recall).
You can log on several times to complete the web survey and save your progress each
time so that you don’t have to complete all of the information and patient profiles at once.
[PN: TICK BOX FOR INSTITUTION APPROVAL] In some countries it is necessary to get permission from your hospital/institution to take part in market research. Please confirm that you understand that you may need approval from your hospital/institution, and that
if required, it is your responsibility to obtain this.
[PN: NEW SCREEN]
Adverse events
We are required to pass on to our client details of adverse events that are raised during the course of market research. Although this is an online market research study and how you will respond will, of course, be treated in confidence, should you raise an adverse event in a specific patient we will need to report this, even if it has already been reported by you directly to the company or the regulatory authorities (UK ONLY
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
“using the MHRA's ‘Yellow Card' system”). In such a situation you will be contacted to ask whether or not you are willing to waive the confidentiality given to you under the market research codes of conduct specifically in relation to that adverse event.
Everything else you say during the course of the study will continue to remain confidential.
[PN: TICK BOX HERE FOR CONSENT] I confirm that I have read, understood, and accept the points above and am happy to proceed with the market research study on this basis.
Help / Pour assistance / Hilfe / Per assistenza / Ayuda / Ajuda: mail to:
TechHelp@medefield.com
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[PN: NEW SCREEN]
First of all we would like you to answer some background and profiling questions, which will take about 8 minutes.
[PN: NEW SCREEN]
A1 Setting
What percentage of your time is spent working with in-patients versus out-patients?
Type in % for each
1. In-patients %
2. Out-patients
Total:
%
MUST SUM TO 100%
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5.
6.
7.
8.
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
A2 Estimated prescribing
Thinking about the patients with schizophrenia that you see in a typical month, approximately what proportion would be prescribed each of the following treatments?
Type in % for each. Your total may sum to more than 100% due to combination therapy
2.
3.
Atypical orals
1.
4.
9.
OLANZAPINE
RISPERIDONE
CLOZAPINE
QUETIAPINE (Seroquel)
[PN: IN FR SHOW “ QUETIAPINE (Xeroquel)” ]
ARIPIPRAZOLE (Abilify)
PALIPERIDONE (Invega) [PN: DO NOT SHOW IN FI, FR, NO, PL]
AMISULPRIDE [PN: DO NOT SHOW IN CA, FI, SW]
ZIPRASIDONE (Zeldox) [PN: DO NOT SHOW IN FR, UK]
[PN: IN BR SHOW “ ZIPRASIDONE (Geodon)”
[PN: IN DK SHOW “ ZIPRASIDONE (Geodon/Zeldox)”
ASENAPINE (Sycrest) [PN: DO NOT SHOW IN FR, PL]
[PN: IN AU,BR,CA SHOW “ ASENAPINE (Saphris)”
Other
___%
___%
___%
___%
___%
___%
___%
___%
___%
___%
10.
Atypical depot
11.
12.
RISPERIDONE (Risperdal Consta)
[PN: IN DK, DE, NO, PL, SW SHOW “ RISPERIDONE” ]
___%
PALIPERIDONE PALMITATE (Xeplion) – SHOW IN DK, FI, DE, NO, ES, SW,
UK
___%
PALIPERIDONE PALMITATE (Invega Sustenna)” - SHOW IN AU, BR, CA
[PN: DO NOT SHOW IN FR, IT, PL]
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OLANZAPINE PAMOATE (Zypadhera)
13.
[PN: IN AU SHOW “OLANZAPINE PAMOATE (Zyprexa Relprevv)”]
[PN: DO NOT SHOW IN BR, CA]
Other
14.
Typical oral
15
16
17
20.
21.
22.
23.
24.
18
19.
Typical depot
HALOPERIDOL
LEVOMEPROMAZINE [PN: DO NOT SHOW IN AU]
CHLORPROMAZINE [PN: DO NOT SHOW IN DK, DE, PL, SW]
ZUCLOPENTHIXOL
Other
FLUPHENAZINE [PN: DO NOT SHOW IN DK, FR, NO, PL]
HALOPERIDOL [PN: DO NOT SHOW IN ES]
ZUCLOPENTHIXOL
FLUPENTIXOL [PN: DO NOT SHOW IN BR, FR, IT, ES]
Other
___%
___%
___%
___%
___%
___%
___%
___%
___%
___%
___%
___%
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A3 Unmet needs
Thinking in general about current treatments for schizophrenia, which of these areas do you feel require most improvement?
Please select up to 7 options from the list below
Efficacy
1. Control of positive symptoms
2. Control of negative symptoms
3. Early treatment response
4. Relapse prevention/maintaining treatment response
5. Control of aggressive symptoms (e.g. hostility and agitation)
Side effects
6. Control of metabolic side effects (including weight gain)
7. Control of extrapyramidal side effects (including tardive dyskinesia, but excluding akathisia)
8. Control of akathisia
9. Control of prolactin-related side effects (including sexual dysfunction)
10. Control of sedation
General attributes
11. Mode of administration
12. Availability of atypical depots
13. Frequency of dosing
14. Transition from oral to depot medication
15. Requirement for blood monitoring and/or liver function/liver status
16. Cost/ reimbursement
17. Patient adherence
Patient relevant outcomes
18. Overall quality of life
19. Patient satisfaction with treatment
20. Level of functioning (e.g. in social situations, being able to live independently)
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Other
98. Other, please specify_____________
99. None of the above [PN: EXCLUSIVE]
[PN: MULTICODE; ROTATE OPTIONS WITHIN EACH SUB-GROUP]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
A4 Level of adherence among physician’s patients
What proportion of your patients are adherent, partially adherent or non-adherent to their prescribed treatment regimen?
Type in % for each
1. Fully adherent i.e. take their medication all of the time
2. Partially adherent i.e. take their medication most of the time
3. Non-adherent i.e. take their medication occasionally/not at all
%
%
%
MUST SUM TO 100%
A5 Establishing a patient’s level of adherence to treatment regimen
How do you establish the level of a patient’s adherence (i.e. fully, partially or non-adherent) to treatment?
Please select all that apply
1. Ask patient
2.
3.
Ask accompanying caregiver
Ask psychiatric nurse
4. Judge based on severity of symptoms (whether exacerbated, stable, or improved)
4. Use an adherence aid e.g. MEMS cap
99. Other, please specify_____________________________________
[PN: MULTICODE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
A6 Reason for non-adherence
What do you think are the main reasons for patients not adhering or only partially adhering to their treatment regimen?
Please select up to 5 options from the list below
1. Not aware of illness (no insight into disease)
2.
3.
4.
Aware of illness/symptoms, but does not recognise the need for treatment
Aware of illness but unwilling to accept that they have schizophrenia
Belief that they are cured (lack of insight)
5. Other disease symptom(s) affecting ability to take medication (e.g. delusions, hallucinations)
6. Presence of side effects
7. Concerns about potential side effects
8. Lack of family support
9. Complicated medication regimens
10. Forgetting to take their medication
11. Cognitive impairment (not related to schizophrenia e.g. dementia, learning disability)
12. Drug / alcohol abuse
13. Cost of medication
99. Other, please specify ____________________
[PN: MULTICODE MAXIMUM OF 5, DO NOT ROTATE]
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A7 Improving adherence
Please indicate which of the following steps you commonly use to improve non-adherence / partial adherence in your practice, and how much impact these have on adherence.
Please select one option per row
1. Re-engage caregiver/support network
Use, with good impact
Use, with limited/no impact
Do not personally use
2. Switch to other oral antipsychotic with fewer side effects
3. Switch to other oral antipsychotic with perceived improved effect
4. Switch to depot injection
5.
6.
7.
Initiate / add cognitive behavioural therapy (CBT)
Adjust the dose
Discuss reasons for non-adherence with patient
8. Simplify medication routine
99. Other, please specify___________
[PN: SINGLE CODE PER ROW, ROTATE OPTIONS]
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A8 Knowledge of poor insight into disease
Are you familiar with the term ‘anosognosia’?
`1. Yes, to me this means [please specify]______
2. Yes, I have heard of it but not sure what it means
3. No, not at all
[PN: SINGLE CODE]
A9 Establishing level of insight in patients with schizophrenia
Anosognosia means a patient has poor insight into/awareness of their disease.
In your patients with schizophrenia, how do you establish the patient’s level of insight into their disease?
Please type in your answer below
___________________________________________________________________________
___________________________________________________________________________
97. I don’t
[PN: SINGLE CODE]
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A10 Prevalence of poor insight among physicians’ patients
Approximately what proportion of your patients at the current moment fit into each of the following categories in relation to their awareness of their schizophrenia?
Type in % for each
1. Fully aware %
2. Moderately aware (i.e. aware of symptoms, but no insight into need for treatment)
3. Fully unaware
%
%
MUST SUM TO 100%
A11 Improvement of insight into disease
If a patient is moderately aware / fully unaware of their schizophrenia for a year or more, do you believe the patients’ insight into their disease can improve?
Please select one option per row
Yes, insight can improve
Yes, insight can improve, but only to some extent
No, insight cannot improve
Don’t know
1. Moderately aware
2. Fully unaware
[PN: SINGLE CODE PER ROW]
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A12 Impact of poor insight on patient’s prognosis
What do you think are the main consequences of a patient’s poor/low level of insight into their schizophrenia?
Please select up to 3 options from the list below
1. Non-adherence to treatment
2. Worsening of symptoms
3. Lower quality of life (QoL)
4. Lower health-related quality of life (HRQoL)
5. Lower level of functioning
6. Creates mistrust between doctor-patient, making it more difficult to engage the patient in treatment
7. Increased workload for treatment team (e.g. more need for close monitoring of treatment progress, surveillance of adherence to treatment)
8. Increased need for caregiver support
99. Other, please specify____________________________________________
97. I don’t think that poor insight impacts on a patient’s prognosis [PN:
EXCLUSIVE]
[PN: MULTICODE UP TO 3, ROTATE OPTIONS]
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A13a Impact of level of insight on treatment decision
How much impact does the patient’s level of insight into their schizophrenia have on your treatment decision, if any?
1. No impact at all
2. Some impact
3. Major impact
[PN: SINGLE CODE]
A13b Specific impact on depot
[PN: ONLY ASK IF INSIGHT HAS AN IMPACT ON PRESCRIBING DECISION I.E. CODE 2 OR 3 AT
A13A]
Are you more likely to prescribe a depot medication to a patient with…
1. …a high level of insight
2. …a low level of insight
3. ... either high or low insight –it does not have a big influence on my decision to prescribe a depot medication
[PN: SINGLE CODE]
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[PN: NEW SCREEN]
Thank you for completing the first part of the survey.
INSTRUCTIONS FOR SELECTING PATIENTS
We would like you to randomly select 6 adult schizophrenia patients that you are currently managing. Please go to your patient files and start your search with patients whose last name begins with [PN: ROTATE “A”, “K”, “S”].
(Note: this is an arbitrary starting point to ensure that the records pulled will be random).
Using [“A”, “K”, “S”] as a starting point, work through the files alphabetically towards the letter “Z” until you find patients who meet the following criteria:
[PN: IF PHYSICIAN IS ABLE TO ADMINISTER DEPOT (I.E. S5 CODE 1) SHOW
NEXT TWO BULLET POINTS] o A patient who is 18 years of age or over of any type who you have seen in a consultation during the last 24 months – please profile 4 patients meeting this criteria o A patient who is 18 years of age or over who you have seen in a consultation during the last 24 months AND is receiving a depot medication for their schizophrenia – please profile 2 patients meeting this criteria
[PN: IF PHYSICIAN IS NOT ABLE TO ADMINISTER DEPOT (I.E. S5 CODE 2)
SHOW NEXT BULLET POINT] o A patient who is 18 years of age or over of any type who you have seen in a consultation during the last 24 months – please profile 6 patients meeting this criteria
Once you have selected the patients please complete the following questions based on their background information and information taken from their most recent
consultation.
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SECTION B: PATIENT RECORD FORM (16-18 minutes)
BX Patient record form
Please select which patient record form you are currently completing from the below options:
[PN: IF PHYSICIAN IS ABLE TO ADMINISTER DEPOT (I.E. S5 CODE 1) SHOW NEXT TABLE]
1. Patient 1 of any type
2. Patient 2 of any type
3. Patient 3 of any type
4.
5.
6.
Patient 4 of any type
Patient 5 (depot treatment)
Patient 6 (depot treatment)
NUMBER OF DEPOT PATIENTS TO BE MONITORED TO ENSURE MINIMUM HALF OF SAMPLE
INITIATING DEPOT
[PN: IF PHYSICIAN IS NOT ABLE TO ADMINISTER DEPOT (I.E. S5 CODE 2) SHOW NEXT TABLE]
1. Patient 1
2. Patient 2
3. Patient 3
4.
5.
6.
Patient 4
Patient 5
Patient 6
Please complete the following form for this patient as accurately as possible. You should
use patient record forms to ensure that the information you provide is accurate. This information will remain completely confidential and anonymous.
You do not need to save each page, your answers will be saved automatically if you are leaving the survey and intend to resume later.
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[PN: PLEASE SHOW THIS DESCRIPTION AT TOP OF EACH SCREEN FROM THIS POINT
ONWARDS] Patient record form for: [PIPE IN PATIENT ID NUMBER ENTERPoED AT BX]
B0 Date of most recent consultation
Please provide the date of the patient’s most recent consultation.
All patients must have been seen within the last 24 months
______/ _______ (MM/YYYY)
[PN: RANGE: 1900-2012]
B1 Date of birth
Please provide the patient’s year of birth (note, the patient must be 18 years of age or over):
_______ (YYYY)
[PN: RANGE: 1900-1994]
B2 Gender
Please indicate the patient’s gender:
1. Male
2. Female
[PN: SINGLE CODE]
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B3 BMI
Please indicate the BMI of the patient:
1. < 18.5 (underweight)
2. 18.5 – 24.9 (normal weight)
3. 25 – 29.9 (overweight)
4. > 29.9 (obese)
98. Don’t know
[PN: SINGLE CODE]
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B4 Employment status
What is the patient’s employment status?
1. Paid full-time employment
2. Paid part-time employment
3. Attend school / educational program
4. Voluntary work
6. Community service or sheltered work
7. Attend job training programme
8. Retired
9. Housewife / husband
10. Unemployed / on disability
99. Other
98. Don’t know
[PN: SINGLE CODE]
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B5 Family status
What are the patient’s living arrangements?
1. Living alone / independently
2. Living alone with support from a caregiver
3. Living with partner and children
4. Living with partner without children
5. Living with parents
6. Homeless
7. Nursing home / residential care home
8. Sheltered accommodation
99. Other (please specify)_______________
98. Don’t know
[PN: SINGLE CODE]
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B6a Reason for most recent consultation
What was the main reason(s) for the patient’s most recent consultation relating to their schizophrenia?
Please select all that apply
1. Diagnosis
2. Acute episode / relapse
3. Side effects
4. Referral
5. Scheduled or routine follow-up
6. Unscheduled follow-up (e.g. after an acute episode)
99. Other, please specify_______________
98. Don’t know
[PN: MULTICODE]
B6b Action from consultation
What action was taken regarding the patient’s schizophrenia treatment at the most recent consultation?
1. Treatment initiation
2. Treatment change
3. Treatment restart
4. Treatment repeat (no change)
98. Don’t know / not applicable
5. Stop treatment
99. Other, please specify ______________
[PN: SINGLE CODE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
[PN: Show B7a & b on the same screen]
B7a Date of diagnosis
Please provide the date of the patient’s diagnosis with schizophrenia:
__ / __ (MM /YYYY)
[PN: OPEN NUMERIC. RANGE 1-31 /1900-2012. NO FUTURE DATE, ENSURE AFTER DATE OF BIRTH
AT B1]
B7b Number of years in psychiatrists care
How long has the patient been in your care?
________________ weeks / months / years
[PN: NUMERICAL ANSWER. RANGE 1-99]
[PN: Show B8a & b on the same screen]
B8a Number of consultations with patient
How many times have you seen the patient for their schizophrenia in the last 12 months?
______ times
[PN: NUMERICAL ANSWER. RANGE 0-365]
B8b Number of relapses
How many psychotic relapses has the patient experienced in the past 12 months?
1.
None
2. ______ relapses [PN: OPEN TEXT, NUMERICAL ANSWER]
98. Don’t know [PN: MUTUALLY EXCLUSIVE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B9 Patient journey
Thinking about the patient’s schizophrenia, what was the time period between…?
If two events take place on the same day for example diagnosis and initiation of treatment, please enter 0 days. a) … first experiencing symptoms and
first consultation (with yourself or another physician)
___ days/ weeks / months / years
[PN: NUMERIC, RANGE 0-100 FOR ALL, USE
DROP DOWN BOX]
Don’t know / not applicable [PN:
MUTUALLY EXCLUSIVE] b) … first consultation and receiving
diagnosis
___ days / weeks / months / years
[PN: NUMERIC, RANGE 0-100 FOR ALL, USE
DROP DOWN BOX]
Don’t know / not applicable [PN:
MUTUALLY EXCLUSIVE] c) … diagnosis and initiation of treatment
___ days / weeks / months / years
[PN: NUMERIC, RANGE 0-100 FOR ALL, USE
DROP DOWN BOX]
Don’t know / not applicable [PN:
MUTUALLY EXCLUSIVE]
Page 34
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B10a Settings versus disease stages
Please indicate which of the following settings the patient was being managed in for each of the following stages.
[PN: USE COUNTRY
SPECIFIC LIST FROM
S7, EXAMPLE BELOW
IS FOR FRANCE] a. First consultation
Select one b. Diagnosis
Select one c. Treatment initiation
Select one d. Current management
(PN: red font)
Please tick all that apply
Hospital (acute care)
Hospital (chronic/longterm care)
Day hospital (intermediary)
Out-patient clinic (CMP)
Private practice
Private hospital
Judicial/forensic setting
(prison)
Other, please specify
Don’t know / not applicable
PN
-
-
-
[SINGLECODE] [SINGLECODE] [SINGLECODE] [MULTICODE]
Page 35
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B10b Healthcare professionals
And which of the following healthcare professional(s) are/were responsible for each of the following? a. First consultation
Select one
b. Diagnosis
Select one
c. Treatment initiation
Select one
d. Current management
(PN: red font)
Please tick all that apply
Yourself
Primary care practitioner (IN UK
SHOW “GP”)
Other psychiatrist, hospital
Other psychiatrist, office
Neurologist
Clinical psychologist
Geriatrician
Nervenärtze [for
Germany ONLY]
Psychiatric nurse
PN
Paediatrician / adolescent specialist
Other
Don’t know / not applicable
[SINGLECODE] [SINGLECODE] [SINGLECODE] [MULTICODE]
Page 36
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B11 Disease severity (CGI)
How would you rate the severity of the patient’s schizophrenia? Please answer using the following scale, based on either a clinical assessment or your own clinical judgment.
1, normal, not at all mentally ill
2, borderline mentally ill
3, mildly mentally ill
4, moderately mentally ill
5, markedly mentally ill
6, severely mentally ill
7, extremely mentally ill
Don’t know a) At your first involvement b) At the most recent consultation
[PN: SINGLE CODE PER ROW]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
PN: ROTATE ORDER OF PRESENTING THE FOLLOWING TWO QUESTIONS (B12 A & B )
B12a Current status (option 1)
Please indicate the current status of the patient’s schizophrenia using the following options:
1.
2.
3.
Acute
Stable with residual symptoms
Stable without residual symptoms
99. Other, please specify
[PN: SINGLE CODE]
B12b Current status (option 2)
Please indicate the current status of the patient’s schizophrenia using the following options:
1. Acute
2. Response
3. Remission
4. Recovery
99. Other, please specify
[PN: SINGLE CODE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B13 Status scale preference
[PN: ONLY ASK THIS QUESTION ONCE – AT PRF 1]
Do you have a preference for any of the below options when asked to describe a patient’s schizophrenia status?
Scale X:
Acute
Stable with residual symptoms
Stable without residual symptoms
Scale Z:
Acute
Response
Remission
Recovery
1. Scale X
2. Scale Z
3. No preference, either of these options are ok
4. Neither of these options
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B14 Quality of life
How much impact does the patient’s schizophrenia have on the patient’s…?
Please respond on a scale of 1-5, where 1=no impact and 5=profound impact
1 (no impact)
2
3
4
5
(profound impact)
1. Overall quality of life
2. Activities of daily living (e.g. household chores, shopping)
3. Social relationships
4. Ability to work
[PN: SINGLE CODE PER ROW]
B15 Patient’s level of insight
Is your patient aware that he/she has schizophrenia?
1. Fully aware
2. Moderately aware (i.e. aware of symptoms, but no insight into need for treatment)
3. Fully unaware
Don’t know
[PN: SINGLE CODE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B16a Patient circumstances
Please rate the patient’s situation in relation to the following attributes:
Please respond on a scale of 1-5, where 1=very low / very poor and 5=very high / very good
1. Relationship with physician
2. Support from healthcare professionals (excluding treating physician) and social workers or other professional caregivers
3. Support from family and/or friends
1 (Very low / very poor)
4. Socio-economic factors (e.g. financial situation)
5. Current treatment response
6. Previous treatment response
2
3
4
5 (Very high / very good)
Don’t know / not applicable
[PN: SINGLE CODE PER ROW; DO NOT ROTATE RESPONSES, KEEP CODE 1 & 2 TOGETHER]
B16b Patient circumstances: drug / alcohol
To what extent does the patient use/abuse drugs or alcohol?
1.
Does not use at all
2.
Mild use
3.
Moderate use
4.
Severe use / abuse
99.
Don’t know
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B17 Hospitalisation
Has the patient ever been hospitalised for their schizophrenia?
1. Yes, currently hospitalised
2. Yes, within the last 12 months
3. Yes, more than 12 months ago
4. No
98. Don’t know
[PN: SINGLE CODE]
B18 Number of times hospitalised
[PN: ONLY ASK B18, B19 and B20 IF CODE 1 or 2 AT B17]
How many times has the patient been hospitalised for their schizophrenia in the last 12 months?
________ [PN: OPEN TEXT, NUMERICAL ANSWER]
B19 Duration of hospital stay
[PN: ONLY ASK B18, B19 and B20 IF CODE 2 AT B17]
What was the duration of the most recent schizophrenia-related hospital stay?
___ days / weeks / months
[PN: NUMERIC, RANGE 0-100 FOR ALL, USE DROP DOWN BOX]
Don’t know [PN: MUTUALLY EXCLUSIVE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B20 Treatment change at discharge from hospital
[PN: ONLY ASK IF CODE 2 AT B17]
When the patient was discharged from hospital, had the patient’s antipsychotic treatment regimen changed?
1. Yes
2. No
98. Don’t know
B21a Treatment at discharge from hospital
[PN: ONLY ASK IF B20 CODE 1]
How was the patient’s antipsychotic treatment changed during his/her stay in hospital?
Please select all that apply
Antipsychotic treatment…
1. … prescribed for the first time ever (i.e. as first-line therapy)
6. … stopped, with no other therapies initiated
2. … switched from one antipsychotic treatment to another antipsychotic
5. … add-on of antipsychotic drug to regimen
3. .. switch to an antipsychotic (from another therapeutic category)
4. .. switch from an antipsychotic (to another therapeutic category)
7. … change in dosing (of existing antipsychotic)
8. … change in formulation (of existing antipsychotic)
9. Other, please specify________
99. Don’t know
[PN: SINGLE CODE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
[PN: ONLY ASK IF CODE 2 or 3 AT B17]
B21b Discharged on a depot formulation
Was the patient discharged from hospital on a depot formulation?
1. Yes
2. No
99. Don’t know
Page 44
7.
8.
5.
6.
3.
4.
1.
2.
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B22 Current treatments
Which antipsychotic treatment(s) are being prescribed as the patient’s current regimen for schizophrenia?
Please select all that apply
95.
No treatment currently prescribed
Atypical orals
OLANZAPINE
RISPERIDONE
CLOZAPINE
QUETIAPINE (Seroquel)
[PN: IN FR SHOW “ QUETIAPINE (Xeroquel)” ]
9.
ARIPIPRAZOLE (Abilify)
PALIPERIDONE (Invega) [PN: DO NOT SHOW IN FI, FR, NO, PL]
AMISULPRIDE [PN: DO NOT SHOW IN CA, FI, SW]
ZIPRASIDONE (Zeldox) [PN: DO NOT SHOW IN FR, UK]
[PN: IN BR SHOW “ ZIPRASIDONE (Geodon)”
[PN: IN DK SHOW “ ZIPRASIDONE (Geodon/Zeldox)”
ASENAPINE (Sycrest) [PN: DO NOT SHOW IN FR, PL]
[PN: IN AU,BR, CA SHOW “ ASENAPINE (Saphris)”
Other, please specify ___________________________________
10.
Atypical depot
11.
12.
RISPERIDONE (Risperdal Consta)
[PN: IN DK, DE, NO, PL, SW SHOW “ RISPERIDONE” ]
PALIPERIDONE PALMITATE (Xeplion) – SHOW IN DK, FI, DE, NO, ES, SW,
UK
PALIPERIDONE PALMITATE (Invega Sustenna)” - SHOW IN AU, BR, CA
Page 45
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
[PN: DO NOT SHOW IN FR, IT, PL]
13.
OLANZAPINE PAMOATE (Zypadhera)
[PN: IN AU SHOW “OLANZAPINE PAMOATE (Zyprexa Relprevv)”]
[PN: DO NOT SHOW IN BR, CA]
14.
Other, please specify ___________________________________
Typical oral
15
16
17
18
HALOPERIDOL
LEVOMEPROMAZINE [PN: DO NOT SHOW IN AU]
CHLORPROMAZINE [PN: DO NOT SHOW IN DK, DE, PL, SW]
ZUCLOPENTHIXOL
19.
Other, please specify __________________________________
Typical depot
20
FLUPHENAZINE [PN: DO NOT SHOW IN DK, FR, NO, PL]
21
HALOPERIDOL [PN: DO NOT SHOW IN ES]
22 ZUCLOPENTHIXOL
23.
FLUPENTIXOL [PN: DO NOT SHOW IN BR, FR, IT, ES]
24.
[PN: MULTICODE]
Other, please specify __________________________________
[PN: IF THIS IS A DEPOT MEDICATION PATIENT, CHECK THAT A DEPOT IS SELECTED – IF NOT
SHOW ERROR MESSAGE: “This patient should be receiving a depot medication. Please check your responses before moving forward” ]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B23 Side effects
Please indicate which side effects the patient has experienced as a result of taking [PIPE
THROUGH DRUGS SELECTED AT B22] , if any?
97. No side effects [PN: EXCLUSIVE]
1.
2.
Metabolic side effects (excluding weight gain)
Weight gain
3. Extrapyramidal side effects (including tardive dyskinesia) (not including akathisia)
4. Akathisia
5. Prolactin-related side effects (including sexual dysfunction)
6. Sedation
7. Injection site reactions
99. Other, please specify
98. Don’t know [PN: EXCLUSIVE]
[PN: ROTATE OPTIONS]
Page 47
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B24 Current treatment information
[PN: DO NOT SHOW IF CODE 95 AT B22 (I.E. NO TREATMENT CURRENTLY PRESCRIBED)]
Please complete the following information for the patient’s current treatment(s).
Mode of administration
Frequency of dosing
[PN: DROP DOWN LIST,
SINGLE CODE]
Your overall satisfaction with drug
Patient’s adherence with drug
Treatment status - start, repeat, switch, re-start?
1=Fully adherent &3 = Non-adherent
[PN: DROP DOWN LIST, SINGLE
CODE]
1=very poor & 5 = very good
[PN: DROP DOWN LIST,
SINGLE CODE]
IM acute injection
IM depot
Injection
Oral solution
Oral tablet
Monthly
Twice a month
Weekly
Once a day
Date treatment was initially prescribed mm/yyyy
Current dose, per administration
(mg)
[PN: RANGE 0.1-
2000]
Start? (i.e. newly initiated, not used the drug previously)
Restart (have used the drug within the past 6 months)
Repeat?
1.
Fully adherent i.e. take their medication all of the time
2.
Partially adherent i.e. take their medication most of the time
1=very poor
2
3
4
5=very good
Oral dispersible
Other
[PN: DROP DOWN
LIST, SINGLE
CODE]
Twice a day
Three times a day
Four or more times a day
Other
Switch?
Other
[PN: DROP DOWN LIST, SINGLE
CODE]
3.
Non-adherent i.e. take their medication occasionally/not at all
[PN: PIPE IN CURRENT
TREATMENTS FROM
B22, ONE DRUG PER
ROW]
[PN: IF THIS IS PATIENT 5 OR 6, CHECK THAT DEPOT IS SELECTED – IF NOT SHOW ERROR MESSAGE]
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B24b. Dose change
[PN: DO NOT SHOW IF CODE 95 AT B22 (I.E. NO TREATMENT CURRENTLY PRESCRIBED)]
Has a different dose ever been prescribed for any of the patient’s current treatment(s)? If so, please provide details below
Previous dose
Type in previous dose
(mg)
[PN: RANGE 0.1-2000,]
Date dose was changed
Type in date of dose change
Mm/yyyy
Drug dosage not changed
[PN: PIPE IN CURRENT
TREATMENTS FROM B22, ONE
DRUG PER ROW]
Don’t’know
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B25 Previous treatment before depot
[PN: If ‘IM depot Injection’ selected at B24, show B25, B26 & B27, depot related questions and skip B28]
You have indicated that the patient is currently receiving a depot injection medication.
What treatment was the patient receiving before their depot medication?
1. Oral formulation of the same drug
2. Oral formulation of a different drug
3. Another depot treatment
4. No previous treatment [PN: EXCLUSIVE]
98. Don’t know [PN: EXCLUSIVE]
[PN: SINGLE CODE]
B26 Reason prescribed a depot treatment
[PN: If ‘IM depot Injection’ selected at B24, show B25, B26 & B27, depot related questions and skip B28]
Why was the patient prescribed a depot formulation treatment?
Please select all that apply
1. Poor adherence with oral therapy
2. Poor treatment response / residual symptoms
3. Patient request
4. Family request
5. Side effects/tolerability of previous treatment
6. Anticipated side effects/tolerability of prescribed treatment
7. More convenient dosing form
99. Other, please specify _______________________
98. Don’t know [PN: EXCLUSIVE]
[PN: MULTI CODE, ROTATE OPTIONS]
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B27 First prescription of a depot treatment
[PN: ‘IM depot Injection’ selected at B24, show B25, B26 & B27, depot related questions and skip B28]
How many years after the initial diagnosis was the patient prescribed a depot antipsychotic
for the first time?
________ years [PN: OPEN NUMERIC]
Don’t know [PN: MUTUALLY EXCLUSIVE]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B28 Reason not currently on a depot treatment
[PN: ‘IM depot Injection’ is NOT selected at B24]
Why is the patient not currently on a depot formulation treatment?
Please select all that apply
1. Satisfactory adherence with oral therapy
2. Satisfactory treatment response to oral therapy
3. The right drug is not available as a depot formulation
4. Cost/reimbursement
5. Patient unwillingness
9. I never offered a depot formulation to the patient
6. Family unwillingness
8. Low experience / familiarity with depot treatment
7. Practical reason e.g. not being able to attend hospital for injection
10. I am unsure how to approach injections with the patient (e.g. because I don’t want to damage the doctor-patient relationship)
11. Patient current condition/symptoms (e.g. delusions, lack of insight into disease or need for treatment)
12. Formulary restrictions
99. Other, please specify _______________________
98. Don’t know [PN: EXCLUSIVE]
[PN: MULTICODE, ROTATE OPTIONS]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B29 Current symptoms
Please indicate which symptoms the patient currently experiences as part of their schizophrenia.
Please select all that apply
POSITIVE SYMPTOMS
1. Hallucinations
2. Delusions
3. Thought disorder
4. Changes in behaviour
5. Disorganised speech
NEGATIVE SYMPTOMS
6. Lack of interest
7. Social withdrawal
8. Emotional flatness
9. Inability to concentrate
OTHER SYMPTOMS
10. Suicidal thoughts
11. Motor signs
12. Aggression
13. Irritability
14. Sexual dysfunction
15. Cognitive deficits
16. Anosognosia (poor insight into the disease)
99. Other, please specify:_____
98. None [PN: EXCLUSIVE]
97. Don’t know [PN: EXCLUSIVE]
[PN: MULTICODE, ROTATE OPTIONS WITHIN CATEGORY]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B30 Severity of symptoms
[PN: DO NOT ASK IF B29 CODE 96 – DON’T KNOW]
Please indicate the severity of each of the patient’s current symptoms on a 1-3 scale.
Please respond on a scale of 1-3, where 1=mild and 3= severe
1=mild 2=moderate 3=severe
Don’t know
[PIPE THROUGH RESPONSES
SELECTED AT B29 (symptoms)]
[PN: SINGLE CODE PER ROW]
B31 Patient awareness of symptoms
[PN: DO NOT ASK IF B29 CODE 96 – DON’T KNOW]
Is your patient aware that he/she experiences these symptoms?
1. Fully aware
2. Moderately aware
(i.e. aware of symptoms, but no insight into need for treatment)
3. Fully unaware
1.
[PN: PIPE THROUGH
RESPONSES SELECTED
AT B29 (symptoms)]
[PN: SINGLE CODE PER ROW]
99. Don’t know
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B32 Symptom perception in relation to medication
[PN: ASK FOR ALL SYMPTOMS SELECTED AT B29 AND CODED 3 AT B31 (FULLY AWARE]
If your patient is aware that they experience these symptoms, do they believe that the severity of his/her symptoms have diminished due to their current medication?
Yes, consider ably
Yes, somewh at
No, not at all Don’t know
Not applicable
1.
[PN: PIPE
THROUGH
RESPONSES
SELECTED AT B31
ANDN CODED AS
“Aware”]
Page 55
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B33 Reasons for prescribing
Why did you prescribe [PIPE THROUGH DRUGS SELECTED AT B22] to the patient?
Please select all that apply
Symptoms – to treat…
POSITIVE SYMPTOMS
1.
2.
Hallucinations
Delusions
3.
4.
5.
6.
7.
8.
9.
Thought disorder
Changes in behaviour
Disorganised speech
NEGATIVE SYMPTOMS
Lack of interest
Social withdrawal
Emotional flatness
Inability to concentrate
10.
11.
12.
13.
14.
15.
OTHER SYMPTOMS
Suicidal thoughts
Motor signs
Aggression
Irritability
Sexual dysfunction
Cognitive deficits
16. Anosognosia (poor insight into the disease)
Side effects
17. Low risk of metabolic side effects (including weight gain)
18. Low risk of extrapyramidal side effects (including tardive dyskinesia) (not including akathisia)
19. Low risk of akathisia
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
20. Low risk of prolactin-related side effects (including sexual dysfunction)
21. Low risk of sedation
General attributes
22. Mode of administration
23. Frequency of dosing
24. No requirement for blood monitoring and/or liver function/liver status
25. Cost/ reimbursement
26. Anticipated (improved) patient adherence
Patient relevant outcomes
27. Anticipated positive impact on overall quality of life
28. Anticipated positive impact on overall functioning
(cognitive and social)
Other
99. Other, please specify_____________
98. Don’t know [PN: EXCLUSIVE]
[PN: MULTICODE, ROTATE OPTIONS WITHIN CATEGORY]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B34 Anticipated future non-adherence
[PN: ONLY ASK IF CODE 2 OR 3 SELECTED AT B12a]
You described the patient as currently “stable with/without residual symptoms” [insert as chosen in B12a, code 2 or 3] .
Despite the patient being stable, do you anticipate him/her to become non-adherent within the near future?
1. No, I don’t have any reason to anticipate non-adherence in the near future
2. Yes, I anticipate the patient to become non-adherent within the next 3 months
3. Yes, I anticipate the patient to become non-adherent within the next 6 months
98. Don’t know [PN: EXCLUSIVE]
[PN: SINGLE CODE]
Page 58
5.
6.
7.
8.
1.
2.
3.
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B35 Previous treatment
Which antipsychotic treatment(s) were prescribed as part of the patient’s previous treatment
regimen? Do not select all treatments the patient has ever taken, only those that were given as part of the most recent previous regimen.
Please only consider a switch in products (or product formulation) or an addition of a product as a change in regimen; dosage changes are not considered a change in regimen for the purposes of this study.
Please select all that apply
95.
No previous treatment received
Atypical orals
4.
OLANZAPINE
RISPERIDONE
CLOZAPINE
QUETIAPINE (Seroquel)
[PN: IN FR SHOW “ QUETIAPINE (Xeroquel)” ]
9.
ARIPIPRAZOLE (Abilify)
PALIPERIDONE (Invega ) [PN: DO NOT SHOW IN FI, FR, NO, PL]
AMISULPRIDE [PN: DO NOT SHOW IN CA, FI, SW]
ZIPRASIDONE (Zeldox) [PN: DO NOT SHOW IN FR, UK]
[PN: IN BR SHOW “ ZIPRASIDONE (Geodon)”
[PN: IN DK SHOW “ ZIPRASIDONE (Geodon/Zeldox)”
ASENAPINE (Sycrest) [PN: DO NOT SHOW IN FR, PL]
[PN: IN AU,BR, CA SHOW “ ASENAPINE (Saphris)”
Other, please specify _______________________
10.
Atypical depot
11.
RISPERIDONE (Risperdal Consta)
[PN: IN DK, DE, NO, PL, SW SHOW “ RISPERIDONE” ]
Page 59
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
PALIPERIDONE PALMITATE (Xeplion) – SHOW IN DK, FI, DE, NO, ES, SW,
12.
UK
PALIPERIDONE PALMITATE (Invega Sustenna)” - SHOW IN AU, BR, CA
[PN: DO NOT SHOW IN FR, IT, PL]
13.
OLANZAPINE PAMOATE (Zypadhera)
[PN: IN AU SHOW “OLANZAPINE PAMOATE (Zyprexa Relprevv)”]
[PN: DO NOT SHOW IN BR, CA]
14.
Other, please specify _______________________
Typical oral
15
HALOPERIDOL
16
17
18
19.
LEVOMEPROMAZINE [PN: DO NOT SHOW IN AU]
CHLORPROMAZINE [PN: DO NOT SHOW IN DK, DE, PL, SW]
ZUCLOPENTHIXOL
Other, please specify ________________________
Typical depot
20
FLUPHENAZINE [PN: DO NOT SHOW IN DK, FR, NO, PL]
21
HALOPERIDOL [PN: DO NOT SHOW IN ES]
22
ZUCLOPENTHIXOL
23.
FLUPENTIXOL [PN: DO NOT SHOW IN BR, FR, IT, ES]
24.
[PN: MULTI CODE]
Other, please specify __________________________
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B36 Previous treatment information
Please complete the following information for the patient’s most recent previous treatment(s).
[PN: DO NOT SHOW IF CODE 95 AT B35 (I.E. NO PREVIOUS TREATMENT)]
Please complete the following information based on the patient’s previous treatment(s): Mode of administration
IM acute injection
IM depot
Injection
Oral solution
Oral tablet
Oral dispersible
Other
[PN: DROP DOWN
LIST, SINGLE
CODE]
Frequency of dosing
[PN: DROP DOWN LIST,
SINGLE CODE]
Monthly
Twice a month
Weekly
Once a day
Twice a day
Three times a day
Four or more times a day
Other
Dose at point of discontinuation
(mg)
Enter 00 if not known
[PN: RANGE
0.1-2000]
Your overall satisfaction with drug
Patient’s adherence with drug
Duration of treatment
Treatment status - start, repeat, switch, re-start?
1=Fully adherent &3 = Non-adherent
[PN: DROP DOWN LIST, SINGLE
CODE]
Type in number of weeks
Enter 00 if not known
Start? (i.e. newly initiated, not used the drug previously)
Restart ( have used the drug with in the past 6 months
Repeat?
5.
4.
Fully adherent i.e. take their medication all of the time
Partially adherent i.e. take their medication most of the time
[PN: OPEN
NUMERIC
BOX]
Switch?
Other
6.
Non-adherent i.e. take their medication occasionally/not at all
7.
Don’t know
Don’t know
[PN: DROP DOWN LIST, SINGLE
CODE]
1=very poor & 5 = very good
[PN: DROP DOWN LIST,
SINGLE CODE]
1=very poor
2
3
4
5=very good
8.
Don’t know
[PN: PIPE IN PREVIOUS
TREATMENTS FROM
B37, ONE DRUG PER
ROW]
9.
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B36b. Dose change
[PN: DO NOT SHOW IF CODE 95 AT B35 (I.E. NO PREVIOUS TREATMENT)]
Was a different dose ever prescribed for any of the patient’s previous treatment(s)? If so, please provide details below
[PN: PIPE IN
CURRENT
TREATMENTS
FROM B22, ONE
DRUG PER ROW]
Previous dose
Type in previous dose
(mg)
[PN: RANGE 0.1-2000,]
Date dose was changed
Type in date of dose change
Mm/yyyy
Drug dosage not changed
Don’t know
LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B37 Reasons for discontinuing / switching treatment
[PN: DO NOT SHOW IF CODE 95 SELECTED AT B35 IE. NO PREVIOUS TREATMENT]
Why was [ PIPE THROUGH ALL TREATMENTS SELECTED AT B35 WHICH WERE NOT SELECTED
AT B22 ] switched or discontinued from the patient’s previous regimen?
Please select all that apply
1. Poor efficacy/symptom control, please specify symptom(s)
[PN: SHOW DROP DOWN LIST FROM B3, SINGLE CODE]
2. Poor tolerability/complaints about side effect(s)
3. Cost/reimbursement
4. Patient request
5. Family request
6. Availability of a new treatment option
7. Formulary restrictions
8. Inconvenience / not easy to use
9. Mode of administration (i.e. change to different formulation)
99. Other, please specify _______________________
98. Don’t know [PN: EXCLUSIVE]
[PN: SINGLE CODE, ROTATE OPTIONS]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B37b. Poor symptom control
PN: ONLY ASK IF CODE 1 SELECTED AT B37
Which symptom(s) was [ PIPE THROUGH ALL TREATMENTS SELECTED AT B35 WHICH WERE
NOT SELECTED AT B22 ] poor in controlling?
Please select all that apply
15.
16.
99.
97.
98.
POSITIVE SYMPTOMS
1. Hallucinations
2. Delusions
3. Thought disorder
4. Changes in behaviour
5. Disorganised speech
NEGATIVE SYMPTOMS
6. Lack of interest
7. Social withdrawal
8. Emotional flatness
9. Inability to concentrate
OTHER SYMPTOMS
10. Suicidal thoughts
11. Motor signs
12. Aggression
13. Irritability
14. Sexual dysfunction
Cognitive deficits
Anosognosia (poor insight into the disease)
Other, please specify:_____
None [PN: EXCLUSIVE]
Don’t know [PN: EXCLUSIVE]
[PN: MULTICODE, ROTATE OPTIONS WITHIN CATEGORY]
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LUN2827: Schizophrenia Treatment Landscape - Questionnaire
B38 This is the end of the patient record form for patient [PIPE IN RESPONSE FROM BX] out of 6 – thank you for your responses.
[PN: IF PATIENT HAS NOT YET COMPLETED 6 PRFS SHOW:]
Please click ‘forward’ to complete another patient record. If you intend to resume later, simply exit the browser and your responses will be saved automatically.
[PN: PLEASE SHOW THIS QUESTION AFTER PRF6 ONLY]
B39 Thank you for completing [PIPE IN ‘6’] patient records.
I have completed feedback for all of the patients that I am able to and would like to submit my responses for this study
[PN: REDIRECT TO COMPLETE SCREEN]
B40 Numbers of patients that are anticipated non-compliant
[PN: ONLY SHOW IF B39 SELECTED. THIS QUESTION IS ONLY ASKED ONCE]
Of all the patient record forms that you have completed, how many of these patients would you anticipate to be non-adherent to their treatment for schizophrenia?
1. 1 patient
2. 2 patients
3. 3 patients
4. 4 patients
5. 5 patients
6. 6 patients
[PN: SINGLE CODE]
B40 END
This concludes the survey. Thank you very much for your responses.
If you have any final comments please feel free to type these below.
OPEN ENDED QUESTION
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