PDS. Prescription Drug Study

PDS. Prescription Drug Study for 2005

item label type description
PDSA1 Question Have you used prescription drugs in the past year?
PDSA2 Question Who does most of the shopping for the prescription drugs that you take?
PDSA3 Question How many different prescription drugs did you use in the last month?
PDSA4 Question Of those prescription drugs, how many are ones you take on a regular basis (for example every day or every week)?
PDSA5 Question How much do you typically spend of your own money for a month supply of your regular drugs?
PDSA6 Question In a typical month, how many different pharmacies do you get prescription drugs from (including mail order)?
PDSA7 Question Where do you typically get your prescription medicines? (Check all that apply.)
PDSA8 Question How often do you purchase prescription drugs from a supplier in another country such as Canada or Mexico? (Check one.)
PDSA9 Question In addition to your prescription medications, which of the following types of medicines do you regularly use that you buy without a doctor's prescription? (Check all that apply.)
PDSB1 Question Which of these best describes how you pay for prescriptions at the pharmacy you use most often? (Check one.)
PDSB2 Question If you checked "I pay some of the price and insurance pays the rest" in Question B1, do you generally pay a fixed dollar amount for each type of prescription or a percentage of the price? (Check one.)
PDSB3 Question If you checked "fixed dollar amount" in question B2, how much do you pay for each prescription?
PDSB4 Question If you checked "Percentage of the price" in Question B2, what percentage do you pay for each prescription?
PDSB5 Question Does your prescription drug coverage have an annual deductible, that is, an amount you have to pay yourself each year before the insurance will start to help pay? (Check one.)
PDSB6 Question If yes, how much is your deductible?
PDSB7 Question Some prescription drug insurance plans restrict the number, type or dollar amount of prescriptions they will pay for. Check any of the following types of restrictions that your plan has. (Check all that apply.)My plan won't pay at all for some types of drugs............1
PDSB8 Question What is the source of your prescription drug insurance? (If you have more than one source of prescription drug coverage check all that apply.)My employer, a family member's employer, or a former employer............1
PDSB9 Question What is the name of your most important prescription drug insurance plan?
PDSB10 Question Overall, how satisfied are you with your current prescription drug coverage?
PDSB11 Question Over the last year, would you say your prescription drug coverage has: (Check one.)
PDSB12 Question Please tell us anything else about your prescription drug insurance that you think is important that we have not asked about.
PDSC1a Question In the past year, how often did you not fill a new prescription because of the cost?
PDSC1b Question In the past year, how often did you stop taking a prescription medication because of the cost?
PDSC1c Question In the past year, how often did you skip doses of a prescription medication in order to save money?
PDSC2 Question In the past year, have you had any side effects, unwanted reactions, or other health problems from medications you were taking?
PDSC3a Question Did you cut down or stop taking the drug on your own?
PDSC3b Question Did you talk to a doctor about this reaction?
PDSC3c Question Did you visit a doctor's office or emergency room mostly because of this reaction?
PDSC3d Question Did your doctor ask you to cut down or stop taking the medication because of this reaction?
PDSC3e Question Did you take another medication or treatment to treat this reaction?
PDSC3f Question Were you admitted to a hospital overnight mostly because of this reaction?
PDSD1 Question How much if anything, have you seen, read, or heard about the Medicare prescription drug benefit available starting in 2006?
PDSD2 Question Have you read or heard about the Medicare prescription drug benefit from any of the following sources?
PDSD3 Question Have you received anything in the mail about the Medicare prescription drug benefit from any of the following sources? (Check all that apply.)
PDSD4 Question How much would you say you know about the Medicare prescription drug benefits available starting in 2006? (Check one.)
PDSD5 Question Based on what you know right now, how favorable is your opinion of the Medicare prescription drug benefit staring in 2006? (Check one.)
PDSD6 Question Thinking about this prescription drug coverage that will be offered to people on Medicare in 2006, how likely would you be to enroll in the prescription drug benefit offered through Medicare? (Check one.)
PDSD7 Question How much, if anything, have you seen, read, or heard about getting extra help paying for drugs when the Medicare prescription drug benefit becomes available starting in 2006? (Check one.)
PDSD8 Question Have you received a letter from the Social Security Administration explaining how to apply for extra help paying for prescription drugs? (Check one.)
PDSD9 Question Do you intend to apply to Social Security for extra help paying for prescription drugs? (Check one.)
PDSD10 Question Have you received a letter from your current prescription drug insurance provider telling you how your plan compares with the new Medicare prescription drug benefit? (Check one.)
PDSD11 Question What did that letter tell you about how your current plan compares? (Check one.)
PDSD12 Question If you currently get your drug coverage through a current or former employer or union, which of the following do you think will most likely happen with your employer/union coverage when the Medicare prescription drug benefit becomes available in 2006? (Check one.)
PDSD13a Question How helpful do you think the new Medicare prescription drug benefit will be for People with low incomes.
PDSD13b Question How helpful do you think the new Medicare prescription drug benefit will be for People with very high prescription drug costs.
PDSD13c Question How helpful do you think the new Medicare prescription drug benefit will be for People with low prescription drug costs.
PDSD13d Question How helpful do you think the new Medicare prescription drug benefit will be for People with no insurance for drugs.
PDSD13e Question How helpful do you think the new Medicare prescription drug benefit will be for People with good insurance coverage for drugs.
PDSD13f Question How helpful do you think the new Medicare prescription drug benefit will be for A typical person with Medicare.
PDSD14a Question When it comes to making changes in your Medicare coverage, I am more likely to make a wrong choice if I have lots of different options to choose from.
PDSD14b Question When it comes to making decisions about my health insurance coverage, I prefer to have someone knowledgeable decide for me.
PDSD14c Question When it comes to making changes in your Medicare coverage,I prefer to have lots of information about each option.
PDSD14d Question When it comes to making changes in your Medicare coverage,I prefer to choose a plan without help from anyone.
PDSD14e Question When it comes to making changes in your Medicare coverage,Choosing a Medicare plan is a task I would rather avoid.
PDSD14f Question When it comes to making changes in your Medicare coverage,I often feel overwhelmed because there is too much information about each plan to take in.
PDSD14g Question When it comes to making changes in your Medicare coverage,I have difficulty understanding the information about Medicare coverage options
PDSD14h Question Whenever I make a choice about Medicare, I worry it will be the wrong one.
PDSD14i Question I am confused about the changes in Medicare.
PDSD14j Question I am upset about the changes to Medicare.
PDSD15 Question Who do you trust or count on to help you make choices about health insurance? (Check all that apply.)
PDSE1a Question Please write down some information from the label on the prescription bottle:Name and dose of the medication:
PDSE1b Question Please write down some information from the label on the prescription bottle:Date the prescription was filled:
PDSE1c Question Please write down some information from the label on the prescription bottle:Dosage instructions:
PDSE2 Question About how long have you been taking this medication?
PDSE3 Question How much did you pay the last time you filled this prescription?
PDSE4 Question What insurance card or drug discount card did you use when you purchased this prescription?_____ PDS.E5a. This medication is very important for my health.
PDSE5b Question It often gives me unpleasant side effects.
PDSE5c Question It is too expensive.
PDSE5d Question It is the best one available for what it does.
PDSE6 Question In the last year, have you ever missed a scheduled dose of this medication or delayed or not filled a prescription for it? (Check one).
PDSE7a Question How important was Cost for missing a dose or not filling a prescription when that happened?Not at all Important Somewhat Important Very Important PDS.E7b. How important was Unpleasant side effects for missing a dose or not filling a prescription when that happened? Not at all Important Somewhat Important Very Important PDS.E7c. How important was being Away from home for missing a dose or not filling a prescription when that happened? Not at all Important Somewhat Important Very Important PDS.E7d. How important was Forgetting for missing a dose or not filling a prescription when that happened? Not at all Important Somewhat Important Very Important PDS.F1. Please list any other prescription medications that you take (do not include any medications you told us about before in Section E).
PDSG1 Question Please list any medications that you take regularly or often as needed without a doctor's prescription (do not include any medications you told us about before in Section E). Examples could be things like aspirin or antacids or allergy medicine, or herbal medications.
PDSH1 Question Were the questions in this questionnaire answered by the person to whom this questionnaire was addressed, or did someone else answer for that person? (Check one.)
PDSH2 Question Approximately, how long did it take you to complete this questionnaire?(minutes)
Start of PDS. Prescription Drug Study
 

 
End of PDS. Prescription Drug Study