Presentation Authors: Jackson Cabo*, Jeremiah Dallmer, Ryan Hsi, Kelvin Moses, Kristen Scarpato, Nashville, TN
Introduction: Many urologic conditions are chronic, and leftover opiates are often kept due to concern for recurrent disease-specific pain. Opiates leftover from surgery are an important source for opiate misuse, which is the focus of many quality improvement initiatives. Health literacy, defined as the ability to obtain, comprehend, and act on medical information, may have a significant impact on the efficacy of quality improvement initiatives and is an independent predictor of health outcomes in patients with chronic conditions. We therefore sought to determine whether health literacy is associated with opiate-keeping behavior.
Methods: We previously assessed opiate-keeping behavior before and after the implementation of an educational tool detailing FDA-approved methods of opiate disposal in 127 urologic patients. In these patients, we retrospectively obtained Basic Health Literacy Screen (BHLS) scores from the EMR, which is collected from all patients admitted to our institution since November 2010 and was available for 68 patients. BHLS score was categorized as either low (3-12) or high (13-15). We then assessed BHLS scores according to opiate keeping behavior, amount of opiate medication used, and safe disposal practices. Opiate keeping, assessed on telephone interview, was defined as having any leftover medication beyond the immediate postoperative period (>3 weeks after surgery or >4x the duration of the initial post-operative prescription, whichever was longer). Significant associations were determined with Fisher's exact or Wilcoxon rank sum tests.
Results: The average BHLS score among opiate keepers vs non-keepers was 13.1 and 12.3, respectively (p=0.37). Patients who completed their entire prescribed opiate course had lower average BHLS scores than those who did not (11.00 vs 13.2; p=0.04). Patients with low BHLS scores were less likely to have leftover medication than those with high scores, though this difference was not statistically significant (64% vs 87%; p=0.11). Patients who properly disposed of leftover opiates had a higher average BHLS score than those who did not, though this difference was not statistically significant (13.6 vs 12.8; p=0.54).
Conclusions: Patients with lower health-literacy scores were more likely to finish their entire opiate prescription and did not tend to properly dispose of leftover opiates. These data highlight health literacy as a potential indicator for an area of intervention to improve proper opiate disposal with the overarching aim to reduce opiate-keeping behavior.
Source of Funding: Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH)