1. What is your occupation?

Physician Nurse Practioner PA Other

2. What is your medical specialty?

Fam Prac Peds Emer Med Int Med Other

3. Which setting is your primary place of employment?
private practice non-profit hospital fed/local gov't AK Native Health University/Research Community Clinic Other

4. Where are you located?

5. In your opinion, is the amount and variety of asthma education for professionals in your community (check one)
"adequate; we don't need more" "minimal; could use some improvements" "non-existent; desperately needed" "don't know"

6. In your practice, how frequently do you see asthma patients? (check one)

  daily weekly monthly occasionally throughout the year never never

7. In your management of asthma patients, how frequently do you follow the NAEPP (NHLBI) guidelines for treatment of asthma? (check one)

  " nearly always" " most of the time" "sometimes" "rarely" " never

8. What impediments, if any, do you see to using the NAEPP guidelines routinely for your asthma patients? (check all that apply)

I see no impediments at all; I use the guidelines My lack of familiarity with the guidelines Time constraints with my practice I do not see the guidelines as effective in improving my patient management The guidelines are not appropriate for the patients I see Other

9. How often do you provide a written Asthma Action Plan (AAP) for your patients? (check one)

  "nearly always AAP" "most of the time AAP" "sometimes AAP" "rarely AAP" "never AAP"

10. If you provide a written Asthma Action Plan (AAP), what is the source of this plan? (check all that apply)

a standard AAP developed by an outside agency (eg., Amer. Lung Assoc., Asthma & Allergy Fnd of Amer; CDC, etc)

an AAP I have created

an AAP developed for use in a specific school district

no standard form; I just write it on a pad

other

I never use an asthma action plan

11. What impediments, if any, do you see to providing a written Asthma Action Plan for every asthma patient? (check all that apply)

  no impediments at all; I always provide a written AAP

I am unfamiliar with AAP’s or don’t know which one to use

there’s no time during patient visits to provide a written plan

I do not see a written AAP as effective in improving asthma management

a written plan would not be appropriate for the patients I see

I refer almost all asthma patients on to a specialist or other provider, so I don’t have a need to use an AAP