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Sample Survey Questions to Solicit Physician Perception of Value of Pharmacists in the Ambulatory Care Setting

These questions have been used by organizations within Wisconsin to either gather feedback for the addition of ambulatory care pharmacists, or to continue to support the value of ambulatory care services within primary care. Please use as you see fit, and feel free to alter to meet your needs.

  1. I utilize the following pharmacy services (check all that apply):
    • Answers to drug information questions
    • Refer patients for comprehensive medication reviews
    • Refer patients for chronic disease state management
    • Refer patients for education on diseases and medications
    • Refer patients for patient assistance opportunities for expensive medications
    • Request that my patients meet with the pharmacist prior to annual physicals
    • Medicare wellness visits
    • Transitional Care Services
    • Other (please specify)
  2. Please rate the pharmacist(s) on the following - (sale of 1-10 where 10 is the best):
    • Availability to see patients accept referrals and preform pharmacy consults
    • Ability to accurately answer drug information questions in a timely fashion
    • Sufficient knowledge base to function in this setting
    • Ability to assess medication-related problems (i.e. detect non-adherence, side effects, etc.)
    • Professionalism with patients, providers and staff
    • Ability to effectively communicate verbally and in writing (please consider clarity and usefulness of written chart notes)
    • Ability to improve cost effective prescribing for patients
  3. Please rank the value of having a pharmacist presence in the clinic - (scale of 1-10 where 10 is the most value):
  4. Overall, how satisfied are you with the performance of your pharmacist(s) – (scale is 1-10 where 10 is the most satisfied):
  5. What other services would you like to see the pharmacist(s) preform for your patients?
  6. If you could change one thing about the pharmacist service offered in your clinic, what would it be?
  7. In your own words, what are the benefits of having a pharmacist(s) in the clinic?
  8. What would be the impact on your practice if you did not have a pharmacist(s) in the clinic?

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