Appendix 4-C. DI Evaluation Form

North Central Region Exercise

Drug Identification Line Instructions

In addition to the quarantine calls you will be receiving over the next 2 days, the Interactive Response (IR) system has other possible uses in a public health emergency. As a volunteer, we request your assistance in testing one of these additional capabilities.

You have been requested to test the Drug Identification (DI) Line. In the event of a biologically based public health emergency, it may be necessary to distribute antibiotics to the entire Denver Metro region within 48 to 72 hours. Not all Point of Dispensing (POD) locations will be dispensing drugs that have the same appearance. It is also possible for an individual to forget which pills they received or become confused which pills are theirs. An automated inbound call system allows a caller to access this information using pill imprints, color, shape and size.

Using the automated system, please identify the pill pictured below by following the instructions and prompts provided by the IR. Please fill out the evaluation after you complete the call. Thank you for your assistance in testing this communication tool.

Volunteer Name: _____________________________________________________

1. Please call XXX-XXX-XXXX.
2. Using the photo above, follow the prompts to identify this pill.
3. Based on the information provided by the IR, what is this pill?

_____________________________________________________

Please fill out the evaluation questions on the second page, and thank you for your assistance in testing the Drug Identification Line.

Dear Quarantine Exercise Volunteer:

Please answer the following questions regarding your experience using the Drug Identification Line.

Questionnaire responses will use a scale of 1 to 5:

1 = Strongly Disagree
2 = Disagree
3 = Undecided
4 = Agree
5 = Strongly Agree

Please tell us how much you agree or disagree with the following statements:

Question	Strongly Disagree	Disagree	Undecided	Agree	Strongly Agree
1. The directions given by the IR were easy to follow.	1	2	3	4	5
2. The voice on the IR message was easy to understand.	1	2	3	4	5
3. The recorded voice on the IR went at a proper speed.	1	2	3	4	5
4. The recorded voice on the IR was at a proper volume.	1	2	3	4	5
5. I trust that the automated system correctly identified my pill.	1	2	3	4	5
6. I am satisfied with my experience using the IR.	1	2	3	4	5
7. If a public health emergency actually occurred and I needed antibiotics, I would trust receiving health department information via an automated system like the IR.	1	2	3	4	5
8. Based on my experience with the IR, I would prefer to receive information from an automated system vs speaking to a live person.	1	2	3	4	5

Comments (Please use the back of this sheet for additional room if necessary)

______________________________________________________________________________________

______________________________________________________________________________________

Thank you again for your assistance in evaluating this communication tool. Your assistance will allow us to provide important information to a large portion of the region's population in a public health emergency. We believe these tools have the greatest potential to reduce patient surge demands on the traditional health care delivery system facilities and allow public health agencies to focus on epidemiology and control measures.

If you have questions about this tool or the testing process, please contact <Insert Test Coordinator Name> at the <Insert their Agency Name>: <Insert Their Phone#> or <Insert Their E-mail Address>

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