HomeMeds Readiness Survey

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1. Organization and Your Contact Information

Name(Required)
Address(Required)

2. Secondary contact within your organization

Name

3. Please indicate what percentage of your clients fit the following descriptions (these descriptions are not mutually exclusive):

4. Please indicate what percentage of your clients fit into the following service categories:

5. Is your current client assess system computerized?

Is your current client assess system computerized?

6. What percent of your staff (care managers, coaches, etc.) are fully functional in using the computerized client assessment system?

What percent of your staff (care managers, coaches, etc.) are fully functional in using the computerized client assessment system?

7. On average, how many NEW clients do you serve per month?

8. On average, what percentage of your clients receive services through the following methods and/or locations?

Client's Home
Program Office
Phone (Exclusively)

9. After the initial assessment, what is your agency's standard for the maximum time between in-home visits by care mangers?

After the initial assessment, what is your agency's standard for the maximum time between in-home visits by care mangers?

10. After the initial assessment, what is your agency's standard for the maximum time between phone calls to clients by care managers?

After the initial assessment, what is your agency's standard for the maximum time between phone calls to clients by care managers?

11. Currently, do client assessments include documenting vital signs?

Currently, do client assessments include documenting vital signs?

12. Currently, do client assessments include recording vital signs?

Currently, do client assessments include recording vital signs?

13. Currently, do client assessments include inventory of the client's medications?

Currently, do client assessments include inventory of the client's medications?

14. How do care mangers document their client's medications?

How do care mangers document their client's medications?

15. Does your current client contract/agreement contain provisions that would enable you to do the HomeMeds screening and pharmacist intervention without a separate consent?

Does your current client contract/agreement contain provisions that would enable you to do the HomeMeds screening and pharmacist intervention without a separate consent?

16. How would you gather client consent?

How would you gather client consent?

17. How many full time staff do you currently have (please use full time equivalents if necessary)?

18. How many of your care managers (who will be using HomeMeds) have the following credentials:

19. Do you currently have a relationship with a medication consultant (i.e. pharmacist, physician, or nurse practitioner)?

Do you currently have a relationship with a medication consultant (i.e. pharmacist, physician, or nurse practitioner)?

20. How will you pay for the pharmacist/medication consultant needed for HomeMeds?

How will you pay for the pharmacist/medication consultant needed for HomeMeds?

21. Please rate the level of agreement to the following statements from the perspective of the CARE MANAGERS/COACHES/HOME VISIT STAFF:

There has been too much change lately and we need some time to stabilize
Staff express concern regarding their clients' ability to manage their medications
We notice and discuss medication issues for our clients
Staff are resistant to adding responsibilities to their current scope of work, even if it means better patient care
Staff are resistant to using computers and other technologies
We are used to change and welcome innovations that will improve care for our clients
Staff are open to learning new systems and procedures that will benefit their clients
There is too much paperwork and data collection already

22. What is the likelihood that the following barriers would be an issue within your agency?

Other agency priorities and programs
The amount of staff time required to fully integrate HomeMeds into daily practice
Staff scope of work does not currently include these responsibilities
The cost of HomeMeds software (approximately $200/month)
Paying for pharmacist's (or other medication specialist's) advice and consultation
Convincing clients to participate

23. Which of the following groups within your agency would be included in the decision making about whether or not to adopt the HomeMeds System?

Which of the following groups within your agency would be included in the decision making about whether or not to adopt the HomeMeds System?