Revised Screener clean version

Screeners for FDA IMPROVE Survey
ACP & AANP Eligibility Criteria

The eligibility screening process is conducted using preexisting member databases
maintained by AANP and ACP, respectively. Screening based on these databases before
the email recruitment stage reduces the burden on participants. While these databases are
updated with information provided by members, it is crucial to screen participants to
determine whether respondents have the prescribing experience necessary to be eligible
for participation.
AANP
1. Are you clinically practicing in an outpatient setting? Yes/No [Recruit if answer is “Yes”]
2. Approximately how many hours per week do you provide direct patient care as a nurse
practitioner? 0-10, 1-20, 21-30, 31-40, 41-50, 51-60, 61 or more [Recruit if answer is >20 hours]
ACP
1. Are you clinically practicing in primary care? Yes/No

[Recruit if answer is “Yes”]

2. How much time do you spend in an in an outpatient care setting? <25%, 25-49%, 50-74%,
75%+ [Recruit if answer is >50%]
ACP & AANP Demographic Characteristics
Incorporating the following demographic questions as intake questions will ensure equipoise
between ACP and AANP’s collected demographic data and allow for stronger data analysis.
These questions serve to describe survey participants, but will not be used to screen participants
or eliminate their eligibility to participate in the study. These questions will be optional and
placed at the end of the survey to avoid dropout or survey fatigue before the intended survey is
administered. The ACP and AANP survey questions may differ slightly to accommodate
professional differences between NPs and PCPs; these differences have been marked below.
1. Gender
2. Age
3. Ethnicity

[Options: Hispanic, Non-Hispanic, prefer not to answer]

4. Race
[Options: American Indian/Alaska Native, Asian, Native Hawaiian/PI,
Black/African American, White, More than One, prefer not to answer]
5. ACP: Primary specialty. NP: Main practice specialty [primary care, specialty care]
6. Years in PCP/NP practice

[Options: 0-10, 11-20, 21-30, 31-40, 41+]

7. Please select the state in which you practice/of your main practice site. [Options: US states,
Armed Forces, other]
8. Which of the following best describes your practice/main practice site size? [Options: I am
the solo PCP/NP, 2-5 clinicians, 6-10 clinicians, 11-30 clinicians, 31-100 clinicians, 101
clinicians or more.

9. Indicate your primary patient care location/main practice site setting:
[Options:
privately-owned practice (by providers/practice owners), hospital/health system owned,
VC/investor backed, solo provider, federally-qualified community health center, nonprofit, public hospital clinic, hospital (non-ED), hospital ED, urgent care, institutional
residential facility, skilled nursing facility, acute rehabilitation center, other]
10. What statement best describes the health record system at your main practice site/practice for
medication prescribing and management? [Check all that apply options: paper chart,
electronic health record, e-prescribing, clinical decision support for prescribing,
prescription formulary checking, coverage tier for patient costs information/actual
patient cost, not applicable, other (please specify)]

Sample Recruitment Email
Subject: You’ve been selected to participate in the 2016 IMPROVE Survey!
Your name has been selected to participate in the _____________, a nationwide survey being
conducted by the University of Chicago in collaboration with the FDA. This survey will
collect information to provide _________________. Please take twelve minutes and take this
survey online. Your participation in this survey is voluntary and you can exit at any time.
Whether or not you choose to participate will not affect your relationship with AANP/ACP.
Submission of this survey is considered implied consent. Your responses are confidential. If
you have any questions, please contact the AANP/ACP Research Department by email at
or by phone at .
Take me to the survey (active hyperlink)
Or copy and paste this URL into your internet browser:
Sample Informed Consent (beginning of survey)
The aim of this survey is to gather your opinions and perspectives on generic prescribing.
Please note that once you start the survey you cannot go back to questions you already
answered.
Your participation in this survey is voluntary and you can exit at any time. Submission of this
survey is considered implied consent. Any responses you provide will be confidential. If you
have any questions, please contact the ACP/AANP Research Department by email at
or phone at .
This survey will take approximately 12 minutes.