Pneumococcal Pneumonia for Healthcare Providers Survey

Does your healthcare facility/organization vaccinate your adult patients against pneumococcal pneumonia?

Yes

No

Regardless of whether you vaccinate, do you recommend pneumococcal pneumonia vaccination to your eligible adult patients (19-64) who have underlying medical conditions like asthma, COPD, diabetes, or chronic heart disease?

Yes

No

Do you routinely recommend pneumococcal pneumonia vaccination to your patients that are 65 or older?

Yes

No

What barriers do you face that prohibit you from recommending or vaccinating an adult patient against pneumococcal pneumonia? Select all that apply

If Other, Please Elaborate

What questions are your adult patients asking when you recommend pneumococcal pneumonia vaccination?

What common misconceptions do your adult patients bring up when you discuss pneumococcal pneumonia vaccination?

What barriers do your adult patients face that prohibit them from being vaccinated against pneumococcal pneumonia?

Are there any tactics you've found useful to increase vaccine confidence when you discuss vaccination with your adult patients? Select all that apply

Presumptive Approach
SHARE Approach
Motivational Interviewing
Storytelling
Tailoring Vaccine Conversations with Each Patient
Reminder/Recall Systems
Other

If Other, Please Elaborate

What additional information or resources would be helpful when having vaccination conversations with your adult patients? To have within the healthcare facility for reference? To have within the healthcare facility for patient education? Or, to have within the healthcare facility for staff support/education?

What best describes your current health provider license? (Select all that apply) 

Physician
Nurse Practitioner
Physician Assistant
Registered Nurse
Licensed Practical Nurse
Pharmacist
Respiratory Therapist
I don't have a health provider license
Other

If other, write-in

Which of the following best describes your practice or type of work?

Family Practice
General Medicine
Internal Medicine
Public/Community Health
I do not engage in patient care
Other

If you selected other or Internal Medicine above, please elaborate

On average, how many patients do you see per week? Enter "0" if you do not see patients. 

Which of the following best describes the primary setting for your practice?

Academic (teaching or research)
Clinic or ambulatory care
Hospital
Long-term care facility or home health care
Community Health Center
Health Department
I do not engage in patient care
Other

If other, please elaborate

Which of the following describes the areas in which the majority of your patients reside? (Select all that apply) 

Rural
Suburban
Tribal
Urban
I do not engage in patient care
Other

If other, please describe

In which state or territory do you practice? If you practice in multiple states, please select your primary location.

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