Skip to main content

Table 2 Patient self-report of health service utilisation

From: Protocol for economic evaluation alongside the IMPLEMENT cluster randomised controlled trial

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)?