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. 2021 Nov 15;62(3):834–839.e1. doi: 10.1016/j.japh.2021.11.013

Appendix 1.

Medical- and medication-related survey questions

Medical-related questions
  • Which of the following best describes your experience with [chronic disease] DURING the coronavirus/COVID-19 pandemic (compared with before coronavirus/COVID-19)?
    • I have been experiencing more symptoms
    • I have been experiencing less symptoms
    • My symptoms have not changed
  • Diabetes specific questions
    • BEFORE/DURING the coronavirus/COVID-19 pandemic (before March 2020), what was your HIGHEST/LOWEST (estimated) blood sugar reading?
      • Blood sugar reading (mg/dL):
      • I do not check my blood sugar levels
      • I do not know my blood sugar levels
    • Why do you not check your blood sugar levels? (select all that apply)
      • I do not have a glucometer or strips/solution to check my blood sugar
      • My doctor told me that I do not have to check my blood sugar
      • I forget to check my blood sugar
      • I do not think it is necessary for me to check my blood sugar
      • Other (please specify)
  • Hypertension specific questions
    • BEFORE/DURING the coronavirus/COVID-19 pandemic (before March 2020), what was your HIGHEST/LOWEST (estimated) systolic and diastolic blood pressure reading?
      • Systolic and diastolic blood pressure reading (mg/dL):
      • I do not check my blood pressure
      • I do not know my blood pressure
    • Why do you not check your blood pressure? (select all that apply)
      • I do not have a blood pressure machine to check my blood pressure
      • My doctor told me that I do not have to check my blood pressure
      • I forget to check my blood pressure
      • I do not think it is necessary for me to check my blood pressure
      • Other (please specify)
Medication-related questions
  • What type(s) of treatments are you currently receiving for your [chronic disease]? (select all that apply)
    • Oral medication (examples: pill, capsule, liquid)
    • At-home injections
    • IV infusions at a facility
    • I am not taking any medications for my chronic disease
    • Other (please specify)
  • Have you had any problems getting your [chronic disease] medications (refills and/or new prescriptions) DURING the coronavirus/COVID-19 pandemic (since March 2020)?
    • Yes
    • No
    • I do not use [specific] medication
  • What problems did you have getting your [chronic disease] medications? (select all that apply)
    • The doctor's office required an appointment prior to sending the prescription to the pharmacy
    • The doctor's office was closed for in-person visits
    • The doctor's office canceled/rescheduled the appointment
    • The doctor's office was unable to send the prescriptions to the pharmacy
    • The doctor's office visit was not affordable (no or poor insurance coverage, etc)
    • I was not comfortable using telehealth (phone/video call) for my appointment
    • Lack of transportation to doctor's office and/or pharmacy
    • Fear of being exposed to coronavirus/COVID-19
    • Medications were not affordable (no or poor insurance coverage, etc)
    • The pharmacy did not have my medication in stock due to a drug shortage
    • Pharmacy hours changed
    • I am a front-line worker and could not go to the doctor’s office due to risk of coronavirus/COVID-19
    • Other (please specify)
  • Have you ever forgotten to take and/or chosen not to take your [chronic disease] medication(s) as prescribed DURING the coronavirus/COVID-19 pandemic (since March 2020)?
    • Yes
    • No
  • Have you ever adjusted your [chronic disease] medication dose yourself (without doctor recommendation) DURING the coronavirus/COVID-19 pandemic (since March 2020)?
    • Yes
    • No