P-25 Physician perspectives on unnecessary clinical care in Trinidad and Tobago

Methods: An online cross sectional study design and convenience sampling was used to collect data. Attitudes towards unnecessary care and awareness of the international Choosing Wisely campaign were assessed. A descriptive analysis was performed using the Statistical Package for the Social Sciences, Version 23 (SPSS 23 for Windows).

Results: Data from 218 physicians were analysed. Most participants worked in Internal Medicine (n=59, 27.1%) and the majority of participants were junior doctors (n=147, 67.4%). Most participants (n=97, 44.1%) said they rarely recommended low value care to patients while 51.8% (n=113) said their colleagues sometimes recommended low value care. Almost all participants (n=210, 97.1%) were interested in learning more about evidence-based recommendations that could address when a test/procedure is unnecessary. Approximately 40% (n=87) participants agreed that unnecessary tests harmed the environment. Reasons for ordering unnecessary tests included because it was an order from the senior doctor in the specialty or the admitting doctor requested the test (68.3%, n=149), inadequate information (61.5%, n=134), difficulty accessing prior medical records (126, n=57.8) and fear of litigation (57.3%, n=125). Strategies to reduce unnecessary care were training (92.2%, n=201), ease of access to external records (72.9%, n= 159), clinical pathways (64.2%, n= 140) and educational materials for patients (64.2%, n=140)

Conclusion: Unnecessary care is an area of concern in Trinidad and Tobago. Identifying areas of overuse and developing targeted plans to reduce unnecessary care are important next steps.