What does this Questionnaire do?
The Accurx HRT Review questionnaire allows the sending of an online questionnaire to patients to collect information in regard their hormone replacement therapy in order to facilitate the review of their treatment regime.
The questionnaire link is sent via SMS or email. The patient fills in the questionnaire through a browser so can use their phone, tablet, laptop or desktop to complete it.
The responses are returned to the organisation and can be saved directly into the clinical record (EMIS or SystmOne) as a coded entry. The responses can have additional notes added, be assigned to other colleagues and be marked as urgent.
What does it look like for the clinician and patient?
Clinician view of sending a questionnaire 👇
Accurx green toolbar floating above EMIS
Accurx green toolbar floating above SystmOne
The questionnaire compose screen for clinicians 👇
They can edit the SMS message if required.
Patient's perspective of viewing and completing a questionnaire 👇
Questions:
1. Do you know the name of the hormone replacement therapy (HRT) that you want?
Yes
No
No, but I'd like the same one I was given last time
2. What is the name of your HRT?
Enter text
3. Have you started taking any new regular medications or health supplements recently?
(Please include any over-the-counter supplements or medications)
Yes
No
4. Which new medications or health supplements have you started taking since your last prescription?
Enter text
5. Have you been diagnosed with any new health conditions since we last issued your HRT?
(These could be any conditions but in particular: any breast or ovarian conditions, blood clots or a clotting disorder, cancer, heart disease, liver disease, migraines or diabetes)
Yes
No
6. What new health conditions have you been diagnosed with since your last HRT issue?
Enter text
7. Is HRT helping your symptoms?
Yes
No
8. How long have you been taking HRT?
Enter text
9. Are you having any side effects or problems from your HRT?
Yes
No
10. Please describe any side effects or problems here
Enter text
11. Do you have any vaginal dryness or discomfort?
Yes
No
12. Are you up to date with your breast screening (mammogram)?
(A mammogram is a type of X-ray that looks for breast cancer. You should be invited to have a mammogram every 3 years between the ages of 50 and 71 unless you have been told otherwise by a healthcare professional.)
Yes
No
I'm not sure
13. Are you up to date with your cervical screening (smear test)?
(Unless you have been told otherwise by a healthcare professional, you should be invited to have a smear test every 3 years between the ages of 25 and 49, every 5 years from age 50 to 64 and then over 65 if one of your last 3 smear tests was abnormal.)
Yes
No
I'm not sure
14. Do you have a family history of breast cancer?
Yes
No
15. Have you had any new or unexpected vaginal bleeding/spotting?
(Such as after sex, between periods or after 12 months of not having a period)
Yes
No
16. Have you had a hysterectomy?
(A hysterectomy is where you’ve had surgery to remove your womb [uterus].)
Yes
No
17. Are you currently using contraception?
(Please note, HRT does not act as contraception)
Yes
No
18. Which method of contraception do you use?
Enter Text
19. Do you require advice about contraception?
Yes
No
20. What is your smoking status?
Current Smoker
Ex-smoker
Never Smoked
21. How much do you smoke? or How much did you smoke?
<1 cigarette or equivalent per day
1-9 cigarettes or equivalent per day
10-19 cigarettes or equivalent per day
20-39 cigarettes or equivalent per day
40+ cigarettes or equivalent per day
22. How many years did you smoke for?
Enter text
23. Are you able to provide a blood pressure reading?
(As part of the review of your HRT we need an up-to-date blood pressure reading)
Yes
No
24. Are you able to provide a weight and height reading?
Yes, both
Weight Only
Height Only
No
25. Please enter your weight in kilograms.
(If you only know your weight in stone and pounds, please use the converter here)
Enter the number in kg
26. Please enter your height in metres.
(If you only know your height in feet and inches, please use the converter here)
Enter the number in metres
27. Are you considering stopping your HRT?
Yes
No
28. Is there anything else regarding your HRT that you would like to change or discuss?
Enter text
When they have submitted their answers, they will be thanked for completing the survey and sent a confirmation SMS 👇
Clinician view of the Hormone Replacement Therapy Questionnaire response
A red notification indicating a patient response has arrived
Inbox view showing an HRT response for a patient
Updated entry showing when the response was saved to record and by whom.
Users can add internal notes for colleagues relating to the patient response
Users can mark a response as urgent
Users can assign the response to a different team.
SNOMED codes added on response
The codes added are in bold and italics
If able to complete BP at home:
Blood pressure recorded by the patient at home 413153004
Self reported systolic blood pressure (Concept ID: 1162737008 / CTV3 2469)
Self reported diastolic blood pressure (Concept ID: 1162735000 / CTV3 246A)
If able to complete weight and height:
Body weight (observable entity) - 27113001
Standing height (observable entity) - 248333004
Body mass index (observable entity) - 60621009
If selected "current smoker":
Smoker (finding) - 77176002
Trivial cigarette smoker (less than one cigarette/day) (finding) - 266920004
Light cigarette smoker (1-9 cigs/day) (finding) - 160603005
Moderate cigarette smoker (10-19 cigs/day) (finding) - 160604004
Heavy cigarette smoker (20-39 cigs/day) (finding) - 160605003
Very heavy cigarette smoker (40+ cigs/day) (finding) - 160606002
If selected "ex-smoker":
Ex-smoker (finding) - 8517006
Ex-trivial cigarette smoker (<1/day) (finding) - 266921000
Ex-light cigarette smoker (1-9/day) (finding) - 266922007
Ex-moderate cigarette smoker (10-19/day) (finding) - 266923002
Ex-heavy cigarette smoker (20-39/day) (finding) - 266924008
Ex-very heavy cigarette smoker (40+/day) (finding) - 266925009
If selected "never smoked":
Never smoked - 266919005
Additional SNOMED codes:
Finding of tobacco smoking behaviour - 365981007
If selected "current smoker":
Smoking cessation advice - 225323000
Current smoker annual review - 505651000000103
If selected "ex-smoker":
Ex-smoker annual review - 505761000000105
If selected "never smoked":
Non-smoker annual review - 505681000000109
F.A.Q's
Why do you not include the 'Hormone replacement therapy review' SNOMED code?
We don't add this code as the HRT review isn't completed through the questionnaire alone. Review of the information by a clinician is required, who will then make a decision on the correct course of action.