Table 2 |
|
Patient self-report of health service utilisation |
| INSTRUCTIONS: Thinking about your use of health services over the last (7 days/3 months)... |
| Have you received an x-ray in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you attended radiology for an x-ray in the last (7 days/last
3 months)? |
| Have you been hospitalised in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you been hospitalised in the last (7 days/last 3 months)? |
| Have you visited casualty/emergency in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited casualty/emergency in the last (7 days/last 3 months)? |
| Have you visited an outpatient or day clinic in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited an outpatient or day clinic in the last (7 days/3
months)? |
| Have you visited any GP in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited a GP in the last (7 days/3 months)? |
| Have you visited a medical/surgical specialist in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited a specialist in the last (7 days/3 months)? |
| Have you visited any physiotherapist in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you consulted a physiotherapist in the last (7 days/3 months)? |
| Have you visited any osteopath in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited an osteopath in the last (7 days/3 months)? |
| Have you visited any chiropractor in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited a chiropractor in the last (7 days/3 months)? |
| Have you visited any other health provider (OHP1) in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited OHP1 in the last (7 days/3 months)? |
| Have you visited any other health provider (OHP2) in the last (7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, how many times have you visited OHP2 in the last (7 days/3 months)? |
| Have you used any prescription or over-the-counter medications in the last (7 days/3
months)? (YES/NO/NOT SURE) |
| If yes, how many different medications have you used in the last (7 days/3 months)? |
| Have you used any prescription or over-the-counter pain relievers in the last (7 days/3
months)?(YES/NO/NOT SURE) |
| If yes, on how many days have you taken pain relievers in the last (7 days/3 months)? |
| Have you used any prescription or over-the-counter sleeping medications in the last
(7 days/3 months)? (YES/NO/NOT SURE) |
| If yes, on how many days have you taken sleeping medications in the last (7 days/3 months)? |
| INSTRUCTIONS: Thinking about your usual main activity over the last (7 days/3 months)... |
| What is your usual main activity? |
| Full-time student |
| Part-time student |
| Employed |
| Unemployed |
| Not applicable |
| How many hours would you usually spend on your main activity in a week? |
| 0 hours |
| 1–15 hours |
| 16–24 hours |
| 25–34 hours |
| 40 hours |
| 41–48 hours |
| 49 hrs or more |
| Have you spent time away from your usual main activity due to illness or to attend
treatment in the last (7 days/3 months)?(YES/NO/NOT SURE) |
| If yes, how many full days away from usual main activity due to illness in the last (7 days/3
months)? |
| And how many hours away from usual main activity to attend treatment in the last (7
days/3 months)? |
|
|
|
Mortimer et al. Implementation Science 2008 3:12 doi:10.1186/1748-5908-3-12 |
