RBR

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Section 1: Practice/physician demographics

1. Your total number of years in practice

2. Your gender

Male
Female

3. CCFP

No
Yes

4. Country where you received your Physician training (excluding electives)

Canada
Foreign
Both

5. Practice type

Solo
Group (Number)

6. Practice remuneration (Select all that apply)

Fee for service
HSO
FHG, FHN, FHT
Other

7. a. Does your practice teach students/residents?

No
Yes

b. If you answered yes to question 7. a., select all that apply:

medical students
family medicine residents
nurse practitioner students
other

8. Do you use an electronic medical record?

No
Yes

9. Prior to or since entering practice, have you had extra paediatrics training?

No
Yes

Section 2: Well baby/child care in your practice 10. Do you do well baby/child care?

No - end of survey
Yes - continue survey

11. Do you use the Rourke Baby Record (RBR)?

No - end of survey
Yes - continue survey

Section 3: Use of Rourke Baby Record (RBR) for well baby/child care 12. How do you use the Rourke Baby Record (RBR)? (Select all that apply):

To remind you of age appropriate evidence-based components of well baby/child care;
As a charting record of well baby/child visits (ie, a set of Rourke Baby Records is in each child’s chart)
The RBR is used by various health care team members in your office. For example, more health care providers than the physician are involved with well baby/child care visits; your staff record some components of the well baby visit; growth parameters.
As a consultation communication tool (ie, a photocopy of the RBR is sent to paediatric and other specialist/health professional consultations)
For charting growth parameters
For recording use of consultants and/or community health resources
Other uses:

13. How effective is the RBR as a recording/charting tool?
14. How helpful is the RBR for the following:

a. Charting growth parameters?

b. Identifying health problems?

c. Managing identified health problems?

d. Referring identified health problems?

e. Identifying high-risk situations, such as safety issues and family problems?

f. Assessing healthy child development?

g. Addressing parent concerns?

h. Managing your time effectively?

i. Collaborating with other health care team members?

15. Are there other aspects of well baby care that the RBR has been particularly helpful for you/your practice?

Section 4: Future of the Rourke Baby Record (RBR)

16. What suggestions do you have for the next updated version of the RBR?

Section 5: Rourke Baby Record Website

17. How helpful was the website?

18. How relevant/useful was the content?

19. How easy was the site to navigate and use?

20. Did the website contain all the information you were looking for about the RBR?

No
Yes

21. Do you have any suggestions for how to improve the website experience of the RBR?

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