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Appendix M Site Visit Questions These questions should be asked of three groups of providers: primary care physicians (or nurse practitioner?) who are not designated Persian Gulf providers, Persian Gulf physicians/team, and specialists (need to determine if there are specialists assigned to Persian Gulf just as there are primary care physicians). Introductory statement should be made to the effect that this is not intended to be a comprehensive survey. Rather, we are looking for ideas from front-line providers about how they view the system, how well it seems to function vis a vis the guidelines, and what they think could be done to improve the program. Providers 1. How are patients triaged, from your point of view? 2. What type of orientation did you receive regarding this program? 3. What is your understanding of Phase I versus Phase II, that is, how do patients get referred to Phase II? 4. How do you address specific problems? chronic fatigue headache 163

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164 ADEQUACY OF THE VA PERSL4N GULF REGISTRY AND UCAP diarrhea (for specialists, ask their area) 5. How do you define an undiagnosed condition? Would any diagnosis eliminate that patient from the category undiagnosed condition? 6. Who actually sees the patient (conducts the exam)? 7. What kind of feedback do you give the patient? . . . alagnosls ~ PG War related additional options 8. How do you refer a patient to a specialist in Phase I (the PG Registry exam)? How long does it take? Are there any barriers to this? How do you refer a patient for a Phase II exam? How long does that take? Are there any barriers to such a referral? 9. Who manages the patient medically once diagnosis is made? 10. What kind of follow-up do you receive after referral? after diagnosis? That is, do you receive feedback on what happened to the patient? 11. If the illness is deemed non-service related, is Here any contact between yol1 and the community physician caring for the patient? 12. Are there any differences between men and women in the diagnostic or referral process? 13. What do you think of the program? 14. What would you do to improve the program? Outreach 1. Is there a designated staff member or program charged with outreach to Persian Gulf veterans regarding services available to them? Who? 2. What is the message of the outreach? (description of program, number to call, who should apply, etc.)

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APPENDIX M 165 3. What is the facility doing with regard to community outreach for Persian Gulf veterans? . - specific activities scope of activities any evaluation of the effectiveness of outreach Intake Is there a centralized intake point andlor procedure? 2. How are Persian Gulf veterans identified? 3. Once identified, how are Persian Gulf veterans informed about the program? Is there a designated person at the facility to do this? What is the veteran told about the program? 4. How are non-medical personnel being informedltrained regarding the Registry (written materials, workshops, etc)? 5. Who is being trained? (i.e., how is "non-medical personnel" defined?) Access 1. How are appointments scheduled for Phase I? 2. Are there different procedures for those with and without symptoms? 3. What is the veteran told about the actual process of the exam, consultations, etc.?

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