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PATIENT ACTIVATION PHENOTYPES AMONG PATIENTS UNDERGOING SURGERY IN RURAL ALABAMA
Alizeh Abbas
*1, Lauren Wood
1, Wendelyn Oslock
1,2, Robert H. Hollis
1, Alfonsus Adrian H. Harsono
1, Gianina Hernandez Marquez
1, Gregory Kennedy
1, Manu Kaushik
1, Daniel I. Chu
11Surgery, The University of Alabama at Birmingham, Birmingham, AL; 2Birmingham Veterans Affairs Medical Center, Birmingham, AL
Background: Patient Activation (PA), defined as the knowledge, skills, confidence, and motivation to participate in one’s own healthcare, has been associated with better postoperative outcomes and lower healthcare costs. It is unclear if PA is associated with other sociological determinants of health in rural settings. The objective of this study was to explore factors associated with PA among patients undergoing gastrointestinal (GI) surgery in rural settings.
Methods: We conducted a retrospective cohort study of patients undergoing GI Surgery from August 2021 – June 2023 at three hospitals in rural Alabama who completed a validated survey assessing socioecological determinants of health (SEDOH-88). PA was the primary outcome and was measured using the 13-item Patient Activation Measure (PAM-13). PAM scores were dichotomized into low PAM and high PAM. Demographic, comorbidities, and socioecological factors were assessed for association with PA. Statistical analyses included multivariable logistic regression.
Results: A total of 100 rural Alabama patients were included: 44 from Demopolis (Marengo County, Index of Relative Rurality (IRR) where 1 is most rural: 0.55), 27 from Alex City (Tallapoosa County, IRR: 0.46), and 29 from Greenville (Butler County, IRR: 0.54) The median age was 62.9 years, and median BMI was 33.5 kg/m
2. Fifty patients were Black, and 41 patients were White. Most patients were female (59.0%), had Medicaid insurance (59.0%), and had high health literacy [HL] (70.0%). There were 56 (56.0%) patients in the high PAM group and 44 (44.0%) patients in the low PAM group. Patients in the high PAM group were younger (57.9 vs. 66.9 years, p=0.05), were more often non-smokers (94.2% vs. 78.1%, p=0.03), and more likely to have high health literacy (78.6% vs. 59.1%, p=0.04) compared to low PAM patients. On multivariable analysis, after adjusting for all other factors, patients with high health literacy had four times higher odds of having high PAM compared to patients with low HL (OR: 4.11, 95%CI: 1.32-12.76, p=0.01). Given this notable association between PAM and HL, we explored four PAM-HL phenotypes from the data across the three rural sites (Figure 1): High PAM-High HL (n=44), High PAM-Low HL (n=12), Low PAM-High HL (n=26), and Low PAM-Low HL (n=18). A majority of patients in High PAM-Low HL (n=9, 90%) and Low PAM-Low HL (n=14, 82.4%) phenotypes were Black whereas patients in the High PAM-High HL (n=23, 54.8%) and Low PAM-High HL (n=14, 60.9%) phenotypes were more likely to be White (p=0.007). No other sociodemographic differences were seen among the four phenotypes.
Conclusions: More than 40% of patients receiving GI Surgery in rural settings have low PA. High health literacy was most strongly associated with high PA. We identified 4 PA-HL phenotypes which may demonstrate clinical significance.
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