Park Lodge Medical Centre

This survey has been written by Barnet, Enfield and Haringey Primary Care Trust. They have requested all General Practice Surgeries to ask their patients to fill out theis survey. It is intended to discover how much you as a patient are involved in your treatment. You will need to enter the number given to you at the reception before you can fill in this survey.

* denotes answer required

Thank you for taking the time to fill it out.

* 1.

Please enter the number on the ticket you were given at the surgery reception.

* 2.

Aspect 1: Communication
Good communication between you and your healthcare professional is important. To make sure that you had the chance to make decisions about your medicines:

	Yes - fully	Yes - partly	No	Does not apply	Can't remember
Were you happy with the way that your healthcare professional explained your condition and possible treatments?

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* 3.

Aspect 2: Explaining your condition and possible treatments I
Your healthcare profesional should help you to choose what is best for you by explaining how a treatment might help you and any risks.
Did your healthcare profesional:

	Yes - fully	Yes - partly	No	Does not apply	Can't remember
Clearly explains your disease or condition?
talk to you about the pros and cons of the medicine(s)?
Ask what difference you hoped the medicine(s) would make?
Offer you information about each medicine before prescribing it to you?

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Aspect 2: Explaing your condition and possible treatments II
Only answer this question if you answered "Yes" to the question above "Did your healthcare professional offer you information about each medicine before prescribing it to you?"

	Yes - fully	Yes - partly	No	Does not apply	Can't remember
Was their information clear and easy to understand?
Did they check you understood the information?
Did they suggest where you could find more information?

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* 5.

Aspect 3: Making a decision about your treatment
You should be involved in deciding whether or not to have treatment, based on information that your healthcare professional has given you:

	Yes - fully	Yes - partly	No	Does not apply	Can't remember
Was the decision to give you a prescription made by you and your healthcare professional together?
Did you decide NOT to take a medicine that your healthcare professional wanted to prescribe for you?

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If so why did you decide this?

* 6.

Aspect 4: Getting your medicines at the pharmacy or dispensary
When you collect your medicines, the phamacist or person who gives them to you should check that you have all the information you need to help you take them in the right way.

	Yes - fully	Yes - partly	No	Does not apply	Can't remember
Did the person who gave you the medicine (for example, the hospital pharmacist or your local chemist) check if you had any questions (for example, about how much ato take and when to take it)?

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* 7.

Aspect 5: Reviewing your medicines I
If you are on a medicine for a long time, a healthcare professional should talk to you about your medicines from time to time. This is caled a medicines review.

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If Yes who was this (for example a doctor, a nurse or pharmacist)?

Aspect 5: Reviewing your medicines II
Only answer this question if you answered yes to the question before.

During this talk (medicines review) did your healthcare professional ask you:

	Yes - fully	Yes - partly	No	Does not apply	Can't remember
-what you knew about the medicine(s) and how you thought they were affecting you?
-if you had any worries about your medicines (for example, about side effects or becoming dependent on them)?
-if you had any problems with opening bottles or packets, or with the cost of prescriptions, or any other problems that made it difficult for you to take your medicines?
-if you had missed any doses of your medicines recently, or you'd cut down or stopped taking them?

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