MP69-18 IMPACT OF HEALTH LITERACY ON URETEROSCOPY OUTCOMES AMONG KIDNEY STONE PATIENTS

Abstract

INTRODUCTION AND OBJECTIVE: Nephrolithiasis is a disease dependent on patients' self-management; however, little is known on the effect of health literacy on treatment outcomes. We sought to understand the impact of health literacy in this population using the validated Brief Health Literacy Screen (BHLS). METHODS: A retrospective review was conducted of all patients who underwent ureteroscopy for upper tract stones between January and June 2017. Of the 244 patients, BHLS data was available for 105 patients. Demographic, surgical, and postoperative data were collected using the electronic medical record. Opiate usage was obtained from the local controlled substance monitoring database. Univariate and multivariable logistic regression analysis were performed to assess the association of BHLS scores with postoperative complications, stone outcomes, adherence to follow-up and treatment, and opiate use. RESULTS: Mean BHLS score was 13.37 (range 4.09-15.0). 81% of patients attended their initial postoperative visit of which 87.6% maintained subsequent follow-up. On univariate analysis, health literacy did not associate with 30-day complications, ipsilateral stone recurrence or progression, ipsilateral stone events, rates of postoperative follow-up, 24-hour urine collection prescription at initial follow-up, 24-hour urine collection completion by subsequent follow-up, or additional requests for opiates within 30 days. Lower BHLS scores were significantly associated with new chronic opiate usage, defined as obtaining an opiate prescription > 60 days postoperatively without a prior history of chronic usage (OR 0.75, 95% CI 0.59-0.96, p = 0.02). Preoperative opiate prescription patterns were also associated with new chronic opiate usage including increased number of preoperative prescriptions, days supplied, and number of prescribing providers. On multivariable logistic regression, lower health literacy remained a significant predictor of postoperative opiate usage > 60 days (Table 1). CONCLUSIONS: An assessment of health literacy can further screen individuals at risk of postoperative opiate dependence after ureteroscopy. These data identify a need to develop decision-making and counseling tools that account for varying levels of health literacy among kidney stone patients. (Figure Presented).