Use of Probiotics to Prevent Ventilator-Associated Pneumonia: A Survey of Pharmacists’ Attitudes

Appendix 5 – Summary of All Responses

Eligibility 1. Do you practice (either full-time or part-time) as a pharmacist in a hospital? Yes 212 No 1 Total Respondents 213

2. Do you provide clinical coverage on a regular basis in an Intensive Care Unit? Yes 191 No 21 Total Respondents 212

Demographics 3. Is the hospital in which you work affiliated with a university? Yes 137 No 52 Total Respondents 189

4. In what province or territory do you practice? Alberta 20 British Columbia 15 Manitoba 14 New Brunswick 5 Newfoundland and Labrador 4 Nova Scotia 4 Northwest Territories 0 Nunavut 0 Ontario 78 Prince Edward Island 1 Quebec 39 Saskatchewan 10 Yukon 0 Total Respondents 190

5. What is the approximate population of the city/town in which your hospital is located? Less than 100,000 35 100,000 to 200,000 26 200,001 to 500,000 26 More than 500,000 102 Total Respondents 189 Use of Probiotics to Prevent Ventilator-Associated Pneumonia: A Survey of Pharmacists’ Attitudes

6. How many years have you been in practice as a pharmacist? Less than 3 years 19 3 to 5 years 23 6 to 10 years 43 11 to 15 years 44 More than 15 years 61 Total Respondents 190

7. What training have you completed? (Select all that apply) BSc (Pharm) 171 PharmD 42 MSc 41 PhD 1 Residency 72 Fellowship 1 Other 16 Total Respondents 190

ICU Details 8. Which of the following describes the type of ICU in which you work? (Select all that apply) Medical 58 Surgical 46 Mixed Medical/Surgical 132 Neurological 47 Cardiovascular 50 Trauma 49 Burn 18 Pediatric 13 Other 5 Total Respondents 190

9. What percentage of your time is spent in clinical ICU practice? Less than 25% 21 25 to 49% 54 50 to 74% 68 75% or more 41 Total Respondents 184 Use of Probiotics to Prevent Ventilator-Associated Pneumonia: A Survey of Pharmacists’ Attitudes

Opinions Toward Probiotics 10. How often would you consider recommending probiotics for prevention of each condition in the ICU? 1 2 3 4 5 6 7 Not Total Never Always Applicable To Respondents My Practice C difficile 104 29 15 9 5 2 2 7 173 diarrhea Non- C 116 26 9 10 5 0 1 6 173 difficile diarrhea Ventilator 137 18 5 2 0 1 0 8 171 Associated Pneumonia (VAP)

11. How often would you consider recommending probiotics for treatment of each condition in the ICU? 1 2 3 4 5 6 7 Not Total Never Always Applicable To Respondents My Practice C difficile 86 31 18 14 9 3 6 7 174 diarrhea Non- C 106 26 13 12 9 2 0 6 174 difficile diarrhea Ventilator 137 17 4 3 3 0 1 8 173 Associated Pneumonia (VAP)

12. What best describes your opinion about the safety of use of probiotics for prevention of Ventilator Associated Pneumonia (VAP)? 1 2 3 4 5 6 7 Unsure Total Definitely Definitely Respondents Unsafe Safe 0 9 23 26 16 16 8 75 173

13. What best describes your opinion about the efficacy of use of probiotics for prevention of VAP? 1 2 3 4 5 6 7 Unsure Total Definitely Definitely Respondents Inefficatiou Efficacious s 5 34 28 18 6 0 0 81 172

14. Which of the following have significantly influenced your perception of the safety and efficacy of probiotics for prevention of VAP? Clinical Institutional Case Personal Opinion of Results of Popular Other Total Practice Protocol Reports Experience Colleagues Randomized Media Respondents Guidelines Controlled or Lay Trials Press Safety 42 34 31 49 57 50 5 11 147 Efficacy 50 35 18 37 58 56 2 10 146 Use of Probiotics to Prevent Ventilator-Associated Pneumonia: A Survey of Pharmacists’ Attitudes

Probiotics Basics 15. From which sources have you learned about probiotics? (Select all that apply) Conversations with colleagues 128 Conversations with patients 23 Scientific journal articles 111 Presentations (e.g. grand rounds) 64 Multidisciplinary bedside rounds 40 Practice guidelines or institutional protocol 62 Popular media (e.g. commercials or news reports) 25 Personal use of probiotics 10 Pharmaceutical reps or advertising 12 Other 16 Total Respondents 165

16. In terms of your level of knowledge of probiotics, how comfortable would you feel participating in a discussion about whether a patient should receive them? 1 2 3 4 5 6 7 Total Very Very Respondents Uncomfortable Comfortable 19 38 36 36 18 17 5 169

17. What would you estimate to be the cost of a daily dose of probiotics (e.g. 2 capsules of 10 billion CFU each, per day)? Less than $5 to $10 $11 to $20 $21 to $30 $31 to $40 $41 to $50 More than Unsure Total $5 $50 Respondents 86 51 14 3 0 0 0 15 169

18. What is the highest level of evidence currently supporting the use of probiotics for prevention of each condition? Meta- One or Non- Expert Case Physiologic Unsure Total Analysis of More Randomized Opinion Report Rationale Respondents Randomized Randomized or Trials Trials Observationa l Studies C difficile 24 39 18 1 3 2 76 163 diarrhea Non- C 18 26 16 3 3 2 94 162 difficile diarrhea Ventilator 11 17 15 4 4 3 108 162 Associated Pneumonia (VAP) Use of Probiotics to Prevent Ventilator-Associated Pneumonia: A Survey of Pharmacists’ Attitudes

19. What is the highest level of evidence currently supporting the use of probiotics for treatment of each condition? Meta- One or Non- Expert Case Physiologic Unsure Total Analysis of More Randomized Opinion Report Rationale Respondents Randomized Randomized or Trials Trials Observationa l Studies C difficile 21 24 21 5 2 4 86 163 diarrhea Non- C 8 21 18 6 2 4 103 162 difficile diarrhea Ventilator 4 14 12 3 2 3 123 161 Associated Pneumonia (VAP)

Probiotics In Your Hospital 20. Are probiotics available in your institution? Yes 113 No 37 Other 7 Unsure 5 Total Respondents 162

21. Who is responsible for dispensing probiotics in your institution? Probiotics are not available in my institution 27 Pharmacy only 113 Pharmacy and Nutrition/Food Services 9 Department Nutrition/Food Services Department Only 3 Unsure 6 Other 4 Total Respondents 162

22. Approximately how many ICU patients in your practice have been given probiotics in the last year (in any format, for any purpose)? None 1 to 5 6 to 10 11 to 25 26 to 50 51 to 100 More Total than 100 Respondents 62 57 14 16 7 4 3 163 Use of Probiotics to Prevent Ventilator-Associated Pneumonia: A Survey of Pharmacists’ Attitudes

Barriers To Probiotic Use 23. What do you consider to be the main barriers, if there are any, to usage of probiotics in your practice? (Select all that apply)

Provider-Level Barriers Clinicians unsure of indications 89 Conflicting opinions among members of healthcare team 95 Uncertainty about guidelines 83 Safety concerns about use of probiotics 81 Uncertainty about dosing or administration 54 Other 21 Total Respondents 162

Patient-Level Barriers Patient or Substitute Decision Maker refusal 4 Risk of interactions with other medications 16 Comorbidities (e.g. immunocompromise) 106 NPO Order 66 Other 9 Total Respondents 131

Institutional Barriers Probiotics not available in institution 39 Lack of inclusion of probiotics on standard order set 75 Absence of written guidelines or protocol 100 Other 22 Total Respondents 143