AEDD | Survey for Family Members

Community Health Care for Adults and Elders with Developmental Disabilities Research and Training

A Project of the University Center for Excellence in Developmental Disabilities (UCEDD)
funded by the Washington State Developmental Disabilities Council (DDC)

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SURVEY FOR FAMILY MEMBERS

I. EXPERIENCE WITH THE HEALTH CARE SYSTEM

Please circle a letter for each question and fill in the blank if appropriate.

Does the adult with a developmental disability live in an area that is:

a) Urban b) Suburban c) Rural

Does he or she have a primary care physician?

a) Yes
b) No

How many times did he or she receive a routine medical exam in the past 12 months? _____

How many times did he or she go in for urgent care in the past 12 months? ______

What kind of physician does he or she see most often?

a) Family Practice MD
b) Internist
c) Psychiatrist
d) Neurologist
e) Pediatrician
f) Other (please specify)_______________________________________

How many times did he or she see the following health care professionals in the past year?

a) Nurse _____
b) Occupational Therapist _____
c) Physical Therapist _____
d) Social Worker _____
e) Psychologist _____
f) Nutritionist _____
g) Speech therapist _____

How comfortable are you with his or her physician or other health care provider during an appointment?

a) Very uncomfortable
b) Uncomfortable
c) Somewhat uncomfortable
d) Somewhat comfortable
e) Comfortable
f) Very comfortable

How satisfied are you with the health care he or she receives?

a) Very unsatisfied
b) Unsatisfied
c) Somewhat unsatisfied
d) Somewhat satisfied
e) Satisfied
f) Very satisfied

II. BARRIERS TO RECEIVING GOOD HEALTH CARE SERVICES

Please consider each of the potential barriers to health care and rate them from 1 to 5. "1" is a
low barrier; "5" is a high barrier.

	LOW BARRIER			HIGH BARRIER
COMMUNICATING WITH THE PATIENT	1	2	3	4	5
ARCHITECTURAL BARRIERS	1	2	3	4	5
TRANSPORTATION	1	2	3	4	5
DIFFICULTY EXPLAINING THE PROBLEM	1	2	3	4	5
AVAILABILITY OF HEALTH CARE PROVIDER	1	2	3	4	5
HEALTH CARE PROVIDERS DON'T TAKE MEDICAID	1	2	3	4	5
HEALTH CARE PROVIDERS' ATTITUDE	1	2	3	4	5
AVAILABILITY OF MEDICAL RECORDS	1	2	3	4	5
HEALTH CARE PROVIDERS' KNOWLEDGE	1	2	3	4	5
PHYSICIANS' COMFORT WITH PATIENT	1	2	3	4	5
CAPACITY OF OFFICE STAFF	1	2	3	4	5
EXAM ROOMS, WHEELCHAIR SCALES AND OTHER MEDICAL EQUIPMENT	1	2	3	4	5

III. Please list any suggestions you have that might make it easier to provide medical care for adults with developmental disabilities.

____________________________________________________________________________________________________

Is there anything else we ought to know about providing medical care for this population?

____________________________________________________________________________________________________

Thanks for your time.

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Updated 07/22/02

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