Health Care Provider Questionnaire
Name of person responding to questionnaire
Date
-
Month
-
Day
Year
Date
Please select the agency you represent
Please Select
Alpine Medicine and Specialty Practices
Archuleta Integrated Healthcare
Aspire
Pagosa Medical Group
Pagosa Springs Medical Center
What is your position within this organization?
How long have you worked for this organization?
Childhood Immunizations
Does your agency offer childhood immunizations?
Yes
No
What is the self pay cost for this service? Is there a co-pay for those with insurance? (not Medicaid or CHP)
Does a child and/or family need to be an established patient in order to receive childhood immunizations?
Yes
No
Can non-established patients walk-in to receive childhood immunizations?
Yes
No
Please describe the tracking and/or reporting system you use for children immunizations. Please describe to whom this data gets reported.
How long has your agency been offering childhood immunizations?
What is your patient load for childhood immunizations?
Are you planning on continuing to offer childhood immunizations at your facility?
Yes
No
What does it take to continue to offer childhood immunizations?
What would it take to continue to offer childhood immunizations?
Primary Preventive Care
In 2022, how many patients received an annual primary preventive care visit at your facility? Please provide a breakdown (percentage) of annual visits by age [0-5, 6-18, adults (19-29, 30-39, 40-49, 50-64, 65+)] and gender if available.
What is the self-pay cost for an annual visit (doctor's visit) at your facility?
What screening labs are frequently asked for as part of an annual visit?
Please indicate which screening labs are covered as part of an annual visits by insurance according to the Affordable Care Act?
What is the self-pay costs for these screening labs as part of an annual visit?
Please indicate which screening labs that you request for patients are standard across providers/agencies.
Please indicate whether your providers ask patients if they want screening labs as part of their annual visits. And if providers get push back from patients about the costs of labs, what do providers do in these situations?
Community members have shared that they are concerned about costs after the initial annual visit. Can you please describe the process for patients who have abnormal labs or need follow-up after the annual visit? How much does this typically cost the patient (self-pay)? How is this communicated with the patient?
Women's Health
Community members shared interest in access to women's health services in Archuleta County. The following questions are related to women's health.
At present, which of the female providers at your facility offers women's health services? Please describe the scope of the services that they offer.
At present, who among these providers is taking new patients?
What is the wait time for getting established as a patient with these providers?
Please indicate whether patients at your facility seeking women's health services have the option of choosing a female provider?
From your experience, when it comes to seeking women's health services at your agency, which of these options are patients looking for in a provider?
Nurse practitioner
Family practice doctor
Physician assistant
Obstetrician and gynecologist
Female provider
Other
Health Conditions
What are the top 5 health conditions that you are seeing in your facility? Please rank order them.
In 2022, how many individuals did you see for each of these 5 conditions?
For each of these conditions, please describe the services that you offer in your facility. Please indicate what services you refer out to and to whom.
Which of these conditions have a tracking and/or reporting system and to whom?
Besides treatment and referral, do you have any education programs that are offered for these conditions? Please describe.
With regards to children, what childhood chronic health conditions are you seeing (and how many)?
What resources are available to families in Archuleta County when their children are diagnosed with conditions such as asthma, developmental disability, diabetes, obesity, and other such conditions.
Public Health
How could the Public Health Department and/or community agencies support your patients with the prevention and/or management of these conditions? (cancer support groups, diabetes prevention program, lactation support, nutrition classes, food pantry services, and other)?
Are you aware of any education programs that are billable to insurance? Under what circumstances?
Are you currently offering any services in collaboration and/or support of San Juan Basin Public Health (MOU, contract, unmet need, grant funding)?
Yes
No
What services are you currently offering in collaboration and/or support of San Juan Basin Public Health (MOU, contract, unmet need, grant funding)?
How long have you been offering this service(s)?
What is the patient load for this service(s)?
Are you planning on to continue to offer this service and what would it take?
Community Health
What are the alcohol and drug use treatment options available to people in Archuleta County?
What are the alcohol and drug use prevention strategies available to people in Archuleta County?
What are the current practices related to substances such as marijuana, diet, exercise, supplements, and alternative therapy?
Based on your experience, what kind of support do people need to make lifestyle changes?
Language Interpretation
In an effort to increase access to primary preventive health care by Spanish-language community members, individuals from the Spanish Language Equity Group are exploring the idea of becoming Spanish Certified Medical Interpreters.
If these individuals were available to come to your organization to provide Spanish medical interpretation, would you be interested in using this service?
Yes
No
If yes, how would you anticipate using this service at your organization?
If no, what would prevent you from using this service?
Health Fair
Have you participated in a pervious Health Fair in Archuleta County?
Yes
No
If yes, what would you recommend keeping the same or changing to better connect participants to primary care providers?
If no, what have you heard from others that you would recommend keeping the same or changing to better connect participants to primary care providers?
Please indicate some ways your organization is able to outreach to encourage community members to utilize the upcoming 365Health Fair that Healthy Archuleta is hosting in October 2023.
Please describe how your organization can help support community members who visit the health fair get connected to a primary care provider to discuss their lab results.
Health Partner Gatherings
Have you participated in the Health Partner Gatherings coordinated by Healthy Archuleta and held at Archuleta Integrated Health Services?
Please Select
Yes
No
Have you participated in the Health Partner Gatherings coordinated by Healthy Archuleta and held at Archuleta Integrated Health Services?
Yes
No
What has been your experience with these gatherings? What are your hopes for this effort going forward?
Please provide any additional comments you wish to share
Thank you for sharing with us.
If you have any questions, please contact us at fsfearchuleta@gmail.com
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