Common all Versions - GfK MRI

Page 17
PRESCRIPTION DRUGS/HEALTH ATTITUDES
PRESCRIPTION
DRUGS
You Personally:
Used
in last
12 months
PRESCRIPTION
DRUGS
(Continued)
You Personally:
Used
in last
12 months
PRESCRIPTION
DRUGS
(Continued)
108-0
BRANDS:
Abilify ...................... 1
AcipHex. .................... 2
Actonel ..................... 3
Actos. ...................... 4
Adderall. .................... 5
Advair ...................... 6
Allegra/Allegra D .............. 7
Altace ...................... 8
Ambien/Ambien CR ........... 9
Asmanex .................... 0
Astelin ...................... X
Avandia ..................... Y
109-0
Avodart ..................... 1
Boniva ...................... 2
Botox. ...................... 3
Caduet ..................... 4
Celebrex .................... 5
Cialis ....................... 6
Clarinex. .................... 7
Coreg ...................... 8
Crestor ..................... 9
Cymbalta. ................... 0
Detrol/Detrol LA .............. X
Diflucan. .................... Y
110-0
Diovan/Diovan HCT ........... 1
Ditropan XL. ................. 2
Effexor/Effexor XR. ............ 3
Elidel ....................... 4
Enablex ..................... 5
Evista ...................... 6
Flomax ..................... 7
Flonase ..................... 8
Flovent ..................... 9
Fosamax .................... 0
Glucophage/Glucophage XR .... X
Glucovance .................. Y
15S-0
Imitrex ...................... 1
Lamisil. ..................... 2
Levitra ...................... 3
Lexapro ..................... 4
Lipitor ...................... 5
Lunesta ..................... 6
Lyrica ...................... 7
111-0
Mirapex ..................... 1
Nasacort AQ ................. 2
Nasonex .................... 3
Nexium ..................... 4
Norvasc. .................... 5
Ortho Tri-cyclen. .............. 6
Paxil/Paxil CR ................ 7
Plavix ...................... 8
Pravachol ................... 9
Prevacid .................... 0
Protonix. .................... X
112-0
Prozac. ..................... 1
Pulmicort. ................... 2
Requip. ..................... 3
Restasis .................... 4
Restylane ................... 5
Rhinocort ................... 6
Rozerem .................... 7
Seroquel .................... 8
Singulair .................... 9
Spiriva. ..................... 0
Topamax .................... X
Valtrex ...................... Y
15T-0
Vesicare .................... 1
Viagra ...................... 2
Vytorin. ..................... 3
Wellbutrin ................... 4
Zetia ....................... 5
Zocor. ...................... 6
Zoloft. ...................... 7
Number of prescriptions filled for yourself in
the last 30 days 15E-0
Write in number
On the average, how much do you spend out
of pocket per month on your prescription
medication(s)?
$ 15F-0
Write in amount
In the last 12 months, where did you fill a
prescription?
15H-0
Drug Store/Pharmacy .......... 1
Supermarket ................. 2
Discount/Department Store ..... 3
Mail order ................... 4
Internet/Online ............... 5
Other. ...................... 6
You Personally:
CONTRACEPTION
Used in last
(Women) 12 months
15J-0
Depo-Provera ............... 1
Loestrin ................... 2
Mirena .................... 3
NuvaRing .................. 4
Ortho Evra ................. 5
Ortho Tri-cyclen ............. 6
Ortho Tri-cyclen Lo ........... 7
Plan B. .................... 8
Seasonique ................ 9
Yasmin .................... 0
Yaz ....................... X
14R-0
IUD ....................... 1
Diaphragm or Cervical Cap .... 2
3
OTHER (Write In)
HEALTH
ATTITUDES
Please indicate how much you AGREE or DISAGREE with each of the following statements by checking the box that comes closest
to how you feel.
Agree Somewhat Somewhat Disagree
15C Strongly Agree Disagree Strongly
1 2 3 4
1. I go to the doctor regularly for check-ups ....................................... 01
2. I prefer alternative medicine to traditional medical practices ........................ 02
3. Generic medications are as effective as brand-name prescription drugs. .............. 03
4. In general, I feel I eat right .................................................. 04
5. In general, I think herbal supplements are effective ............................... 05
6. I take my prescription medicines exactly as prescribed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06
7. I’m often first to try the most advanced medicines ................................ 07
8. I prefer popular brand-name drugs, even if they cost more ......................... 08
9. I rely on my physician to recommend drug brands. ............................... 09
10. In general, newer drug brands work better than older brands ....................... 10
11. If a drug brand works, I stick with it ........................................... 11
12. To save money, I would buy prescription drugs from countries other than the United States. 12
13. Before I begin taking any drug, I look for as much information about it as possible. ...... 13
14. I am willing to take prescription drugs even if my insurance company doesn’t cover them. . 14
15. Over the counter medications are safer than prescription drugs. . .................... 15
16. I only go to the doctor when I’m very ill. . ....................................... 16
17. Sometimes I skip a dose of my prescription drugs because I worry about the side effects. . 17
18. I take medicine as soon as I don’t feel well. . .................................... 18
19. Medication has improved the quality of my life. .............................. 19
20. I follow a regular exercise routine. ............................................ 20
21. My medical conditions limit my lifestyle somewhat. ............................... 21
22. I am always looking for new ways to live a healthier life. ........................... 22
23. I am happy with my weight. . ................................................ 23
24. I consult my pharmacist for health advice. ...................................... 24