Abstract 353: Patient and Provider Awareness of Unnecessary Testing, Wasteful Medical Spending, and Choosing Wisely

Background: A substantial portion of medical spending, such as unnecessary cardiac imaging tests, does not benefit patients and is therefore wasteful. While estimates of wasteful spending and unnecessary testing are reported in the literature, the degree to which those facts are known by patients and health care providers is not well described. We conducted a survey of patients and providers awareness about waste and hypothesize that patient awareness will be less than providers.Methods: We developed an anonymous survey for patients and healthcare providers. Recruitment was done in primary care and cardiology clinics, in the nuclear cardiology laboratory, and included sites both at our academic medical center and our affiliated Veterans Affairs medical center. We recruited patients who either have had nuclear myocardial perfusion imaging (MPI) or may have one ordered for them. We recruited healthcare providers who commonly order nuclear MPI from primary care, hospital medicine, and cardiology including both physicians and advanced providers. Survey questions were in a variety of formats including yes/no, scale responses, multiple choice, and narrative. When possible, identical questions were asked of patients and providers. Comparisons between the groups were made by chi square test.Results: The survey was completed by 338 patients and 111 providers. Patients were evenly distributed between primary care (36.0%), nuclear medicine (31.9%), and cardiology (32.2%) recruitment sites, with 55.6% being Veterans. Providers were also well distributed among primary care (37.7%), hospital medicine (22.8%), and cardiology (35.1%). Providers more frequently identified the correct total cost (20.9% versus 10.4% by patients, pu003c0.0001) and percentage of costs (77.5% versus 39.3% by patients, pu003c0.0001) of wasteful spending. Patients were less likely than providers to be aware of the Choosing Wisely campaign (2.7% versus 37.2%, pu003c0.0001). Nearly half (137, 43.5%) of patients indicated that sometimes it is “a bad idea to get a test”; the most common narrative reasons included risk of the test (n=11), lack of symptoms (n=10), and the test not being necessary (n=10). Responses from providers regarding inappropriate reasons to order tests included lack of symptoms (n=26), patient or family demands (n=16), and malpractice fears (n=12).Conclusion: Both patients and healthcare providers underestimate the costs of wasteful medical spending, patients to a greater degree. Awareness in both groups of the Choosing Wisely campaign is low. Many patients and providers are cognizant of accurate reasons why a test might be unnecessary.