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  1. Surveys
  2. 2014
  3. September
  4. R
  5. Referral and Reporting
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Exit Survey
 
 
Thank you for agreeing to participate in this research project. The goal of this project is to develop effective referral and reporting between general practice and acupuncture for the treatment of mental health. Your response will help us ensure that the results are valid and applicable to those working in this area. This survey will take between 5-10 minutes to complete.
 
 
 
Have you ever, or would you ever, refer a patient to an acupuncturist?
 
Yes
 
No
 
 
 
Have you ever, or would you ever, refer a patient to an acupuncturist for the care of mental health problems?
 
Yes
 
No
 
 
3. How likely are you to refer to an acupuncturist for the following conditions? (This list is taken from the WHO report “ACUPUNCTURE: REVIEW AND ANALYSIS OF REPORTS ON CONTROLLED CLINICAL TRIALS” but is not an exhaustive list).

Part a. Diseases, symptoms or conditions for which there is significant research on acupuncture efficacy:
Very Unlikely Unlikely Neutral Likely Very likely
Adverse reactions to radiotherapy and/or chemotherapy
Allergic rhinitis (including hay fever)
Depression
Dysmenorrhoea, primary
Headache
Hypertension, essential
Induction of labour
Knee pain
Low back pain
Malposition of fetus, correction of
Very Unlikely Unlikely Neutral Likely Very likely
Morning sickness
Neck pain
Rheumatoid arthritis
Sciatica
Sprain
Stroke
Tennis elbow
 
 
4. How likely are you to refer to an acupuncturist for the following conditions? (This list is taken from the WHO report “ACUPUNCTURE: REVIEW AND ANALYSIS OF REPORTS ON CONTROLLED CLINICAL TRIALS” but is not an exhaustive list).

Part b. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:
Very Unlikely Unlikely Neutral Likely Very Likely
Alcohol dependence and detoxification
Anxiety
Female infertility
Fibromyalgia and fasciitis
Insomnia
Opium, cocaine and heroin dependence
Osteoarthritis
Polycystic ovary syndrome
Posttraumatic Stress Disorder
Premenstrual syndrome
Schizophrenia
 
 
5. If you were to refer to an acupuncturist how important would the following be? (This list is adapted from an accepted referral pathway text.)
Not at all important Somewhat Important Important Very Important N/A
Your belief in acupuncture's efficacy for selected conditions
If a complete medical/physical examination was conducted on the patient
The patient’s previous experience with acupuncture
The patient’s expectations about acupuncture treatment
If research exists concerning the effectiveness of acupuncture treatment
If there are any risks associated with acupuncture treatment
The qualifications of the acupuncturist
If the acupuncturist was also a medically trained doctor
The cost of acupuncture treatment relative to the patient’s financial status
The treatment availability in terms of distance and time
The route of administration (i.e. needles)
If the treatment requires the patient’s active or passive participation
Your responsibility for referral outcomes
The patients cultural beliefs
 
 
 
What information would you think necessary to include in a referral form to an acupuncturist? Tick all that apply
 
Presenting problem
 
Reason for referral
 
Western medical Diagnosis
 
Outcome measures
 
Disabilities
 
Patient information
 
Referrer details
 
Red flags
 
Private or public funding
 
Other
 

 
 
 
What information would you expect in a return report from your acupuncturist? Tick all that apply.
 
Number of treatments
 
Dates of treatments
 
Therapies uses
 
Outcome measures (e.g.MYMOP scores)
 
Goals of treatment
 
Treatment outcomes
 
Other
 

 
 
 
What frequency would you expect return reports?
 
After each treatment
 
Monthly
 
After conclusion of treatments
 
Other
 
 
 
 
Do you have any addition comments regarding referral to acupuncture that you would like to include in the results of this survey?
   
 
 
 
How many years have you been in general practice?
 
Less than 2 years
 
2-5 years
 
5-10 years
 
10-20 years
 
More than 20 years
 
 
 
Are you in a city, urban, suburban or rural practice?
 
City
 
Urban
 
Suburban
 
Rural Practice
 
Other
 
 
 
 
Are you in a solo or group practice?
 
Solo
 
Group
 
 
 
What age group do you belong to?
 
20-30
 
31-40
 
41-50
 
51-60
 
>61
 
 
 
Have you ever experienced acupuncture as a patient?
 
Yes
 
No
 
 
 
Have you ever administered acupuncture yourself?
 
Yes
 
No
 
 
 
If you would be willing to be contacted for a follow up focus group, please put your email here: