ADACGMONE

POST-PRESENTATION SURVEY

Q3	Please describe your practice setting:
Q3		Solo Practice	Group Practice	Hospital Setting	Clinic	Other
		Solo Practice	Group Practice	Hospital Setting	Clinic	Other

Q5	Please rate the following:
Q5		Unsatisfactory	Needs Improvement	Average	Above Average	Excellent
	Degree to which educational expectations met	Degree to which educational expectations met Unsatisfactory	Degree to which educational expectations met Needs Improvement	Degree to which educational expectations met Average	Degree to which educational expectations met Above Average	Degree to which educational expectations met Excellent
	Material was relevant to my practice	Material was relevant to my practice Unsatisfactory	Material was relevant to my practice Needs Improvement	Material was relevant to my practice Average	Material was relevant to my practice Above Average	Material was relevant to my practice Excellent
	Effective Faculty Presenters	Effective Faculty Presenters Unsatisfactory	Effective Faculty Presenters Needs Improvement	Effective Faculty Presenters Average	Effective Faculty Presenters Above Average	Effective Faculty Presenters Excellent
	Overall Program	Overall Program Unsatisfactory	Overall Program Needs Improvement	Overall Program Average	Overall Program Above Average	Overall Program Excellent

Q6	As a result of what you have learned during this program, will you change your practice behaviors?
Q6		No	Unlikely	Unsure	Probably	Absolutely
		No	Unlikely	Unsure	Probably	Absolutely

What changes will you make to your practice behaviors?

I will prescribe CGM for more of my patients.

I will educate my colleagues about CGM.

I will educate my patients about CGM

I will make sure that I'm reviewing the AGP

I will empower my patients to figure out which CGM might be right for them

I will consider CGM for all my patients with diabetes

I will make sure our office is ready for CGM

Other

Q8	If you selected "Other," please describe what you will change.

Q9	What barriers to change do you foresee, if any? Select all that apply.
Q9		Cost	Insurance Coverage	Formulary	Time with Patient	Patient compliance	Other
		Cost	Insurance Coverage	Formulary	Time with Patient	Patient compliance	Other

Q10	If you selected "Other," please describe the barrier(s) you foresee.

Q11	Did the content contribute valuable information that will assist in improving patient outcomes?
Q11		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree

Q12	Please rate your ability to achieve the Learning Objectives of this presentation:
Q12		Not at all	Somewhat	Mostly	Completely
		Not at all	Somewhat	Mostly	Completely

Q13	What was your level of expertise on this topic?
Q13		None	Little	Some	Considerable	Extensive
	BEFORE	BEFORE None	BEFORE Little	BEFORE Some	BEFORE Considerable	BEFORE Extensive
	AFTER	AFTER None	AFTER Little	AFTER Some	AFTER Considerable	AFTER Extensive

Q14	Do you believe the activity was fair and balanced, free from commercial influences?
Q14		Yes	No
		Yes	No

Q15	Did the program increase your competence?
Q15		Yes	No
		Yes	No

Q16	Does an A1c of less than 7% indicate good glucose control?
Q16		Yes	No	Not necessarily
		Yes	No	Not necessarily

Q17	The recommended "Time in Range" for an elderly person is greater than, less than, or the same as for your average patient with diabetes?
Q17		Greater than	Less than	The same
		Greater than	Less than	The same

Q18	How confident are you in your answer to the last question?
Q18		Not at all	Somewhat	Confident	Very confident
		Not at all	Somewhat	Confident	Very confident

Q19	Click submit to move to printing your certificate and add any additional comments you may have below. Thank you!