Surveypoint

Q01

Vignette form no.

Q02

Name of interviewer

Q03

Place of Interview

Q04

Date

Q05

Designation

Q06

Age

Q07

Gender

Q08

Type of Facility

PHC

CHC/CHC FRU

DH/SDH

Medical College

Private Hospital

A01

Did the doctor…

A02

…greet the patient and/or introduce themselves?

Yes

No

A03

…ask if the patient has headache?

Yes

No

A04

…ask if the patient has chest pain?

Yes

No

A05

…ask if the patient has lightheadedness?

Yes

No

A06

…ask if the patient has palpitations?

Yes

No

A07

…ask if the patient has blurry vision?

Yes

No

A08

…ask if the patient has shortness of breath?

Yes

No

A09

…ask if the patient has lower extremity edema?

Yes

No

A10

…ask if the patient is drinking too much water?

Yes

No

A11

…ask if the patient is urinating more than usual?

Yes

No

A12

…ask about tobacco use?

Yes

No

A13

…follow-up with questions characterizing smoking history?

Yes

No

A14

…ask about alcohol consumption?

Yes

No

A15

…ask about regular exercise?

Yes

No

A16

…ask about diet/adding salt to food?

Yes

No

A17

…ask about family history of heart disease or heart attacks or high blood pressure?

Yes

No

A18

…ask if the patient has any other illnesses?

Yes

No

A19

…ask if the patient is taking any medications for the high blood pressure?

Yes

No

A20

…ask if the patient is taking any other medications for any other reason?

Yes

No

B01

Does the doctor…

B02

…ask for a blood pressure measurement?

Yes

No

B03

…ask for heart rate?

Yes

No

B04

…ask for a respiratory rate?

Yes

No

B05

…repeat the blood pressure measurement (after at least five minute of being seated)

Yes

No

B06

…ask for weight + height and/or BMI?

Yes

No

B07

…conduct fundal exam

Yes

No

B08

…examine the neck (thyroid and/or carotids)?

Yes

No

B09

…examine the heart?

Yes

No

B10

…examine the lungs?

Yes

No

B11

…examine the abdomen?

Yes

No

B12

…examine the lower extremities (pulses and/or edema and/or skin)?

Yes

No

B13

…conduct neurologic exam?

Yes

No

C01

What additional diagnostic tests do you need if any? Please indicate when you have finished gathering information on additional diagnostic.

C01_1

Electrocardiogram

Yes

No

C01_2

Lipid Profile (Cholesterol)

Yes

No

C01_3

Renal Function Test (basic metabolic panel)

Yes

No

C01_4

Point of care (random) blood sugar

Yes

No

C01_5

Fasting Blood Sugar and/or HbA1C

Yes

No

C01_6

Urinalysis (check)

Yes

No

D01

Did the medical officer diagnose hypertension?

Yes

No

D02

Did the medical officer diagnose comorbid diabetes mellitus?

Yes

No

D03

Did the medical officer also diagnose hyperlipidemia?

Yes

No

E01

…counsel about hypertension and its management ?

Yes

No

E02

…counsel about diabetes and its management?

Yes

No

E03

…offer tobacco cessation counselling

Yes

No

E04

…advise about improving physical activity

Yes

No

E05

…advise about reducing salt intake

Yes

No

E06

…offer appropriate first-line medication for hypertension.

Amlodipine (Calcium Channel Blocker)

Enalapril (ACE Inhibitor)

Ramipril (ACE Inhibitor)

Lisinopril (ACE Inhibitor)

Telmisartan (ARB)

Losartan (ARB)

Indapamide (Diuretic)

Atenolol (Beta Blocker)

Metoprolol (Beta Blocker)

Any other

E06A

Write down all the numbers

E07

…advise increasing dose of metformin

Yes

No

E08

… advise initiating Statin Drug (atorvastatin/ rosuvastatin/ simvastatin) for lowering cholesterol

Yes

No

E09

….inform the medicine schedule to the patient

Yes

No

E10

…inform the side effects of the medicines to the patient

Yes

No

E11

…advise to return after two weeks for follow-up blood pressure measurement

Yes

No

E12

…advise about danger signs and returning to the facility immediately in case of any complication

Yes

No

F01

Clinical Vignette Template 1 -Form Fill