Physician perspectives on low value care in Trinidad and Tobago- a cross sectional survey

Objective: To evaluate the views of physicians in Trinidad and Tobago towards low value care Methods: Physicians were surveyed using a cross sectional study design. An online questionnaire was disseminated through social media platforms using convenience sampling. A descriptive analysis was performed. 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. 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: Low an area of concern in Trinidad and Tobago. Identifying areas of overuse and developing targeted plans to reduce unnecessary care are important next steps.