The Impact of an Educational Intervention on Enhancing Clinical Knowledge of Physicians and Pharmacists Regarding Statins and Monitoring Parameters: The Experience of a Tertiary Teaching Hospital

Figures & data

Table 1 Participants Demographic Characteristics (N= 47)

Demographic characteristics	Frequency (N)	Percentage (%)
Gender
Male	31	66
Female	16	34
Age (Years) (mean= 26.36 years)
<25	16	34
25–29	23	49
≥30	8	17
Professional designation
Physicians	12	25.5
Registered Pharmacists	15	31.9
PharmD trainee	20	42.6
Did you attend workshops for your professional development during the last year?
Yes	20	42.6
No	27	57.4
Did you attend any lectures or workshops on cholesterol management during the last year?
Yes	10	21.3
No	37	78.7

Table 2 Comparison of the Awareness to General Knowledge Questions Pre-and Post-Educational Intervention

Awareness level	Pre-intervention	Post-intervention	p-value ^a
Aware of some, most, or all of the content of the 2018 ACC/AHA cholesterol management guideline	23 (48.9%)	35 (74.5%)	<0.001
Aware of some or all the parameters used in the Framingham CVD risk calculator	19 (40.4%)	37 (78.7%)	<0.001
Aware of some or all the parameters used in the ACC/AHA 10-year ASCVD Risk calculator	22 (46.8%)	36 (76.6%)	<0.001

Note: ^aUsing McNemar test.

Abbreviations: ACC/AHA, American College of Cardiology/American Heart Association; ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease.

Table 3 Comparison of the Responses to ASCVD Risk Assessment Knowledge Questions Pre- and Post-Educational Intervention

Questions	Correct answers		P-value^a
	Pre-intervention	Post-intervention
For primary prevention of ASCVD, a 10-year risk calculation is recommended for which age category? Correct answer (40–75 years old)	31 (66%)	43 (91.5%)	0.004
For primary prevention of ASCVD, a lifetime risk calculation instead of a 10-year risk calculation is advocated for which age category? Correct answer (20–39 years old)	12 (25.5%)	26 (55.3%)	0.003
The ACC/AHA stratify individuals according to their 10-year ASCVD risk into: Correct answer (Low, borderline, intermediate, and high risk)	10 (21.3%)	32 (68.1%)	<0.001
A 40 years old male smoker patient with DM and HTN falls into which risk category for future ASCVD Events? Correct answer (High risk)	24 (51.1%)	28 (59.6%)	0.454
According to the 2018 ACC/AHA guideline on the management of blood cholesterol, a 65 years old smoker patient with a history of myocardial infarction (MI) falls into which risk category for CVD? Correct answer (Very high risk)	28 (59.6%)	32 (68.1%)	0.481
During cardiovascular risk assessment for primary prevention, does the presence of chronic inflammatory conditions (such as rheumatoid arthritis, psoriasis, etc.) enhance the individual ASCVD risk? Correct answer (Yes)	19 (40.4%)	30 (63.8%)	0.001
In adults not on lipid-lowering therapy, measurement of a non-fasting plasma lipid profile is effective in estimating ASCVD risk? Correct answer (Yes)	23 (48.9%)	28 (59.6%)	0.359
The ACC/AHA 10-year ASCVD risk calculator may underestimate risk in: Correct answer (Patients with chronic inflammatory diseases)	13 (27.7%)	25 (53.2%)	<0.001
Coronary Artery Calcium Score (CAC) can be useful to refine risk assessment and aid in decision making about statin use, mostly in: Correct answer (Individuals with 10-year ASCVD risk 7.5% - <20%)	24 (51.1%)	30 (63.8%)	0.238

Note: ^aUsing McNemar test.

Abbreviations: ACC/AHA, American College of Cardiology/American Heart Association; ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; DM, Diabetes mellitus; HTN, Hypertension.

Table 4 Comparison of the Correct Responses to the Clinical Knowledge of Statin Therapy Pre- and Post-Educational Intervention

Questions	Correct answers		P-value^a
	Pre-intervention	Post-intervention
It is recommended to initiate statin therapy without ASCVD risk assessment in all the following patients EXCEPT: Correct answer (Obese and smoker patient aged 42 years old)	14 (29.8%)	25 (53.2%)	0.019
What percent of LDL-C reduction would you expect from low, moderate and high-intensity statin daily therapy? Correct answer (< 30% for low, 30- <50% for moderate, and ≥50% for high-intensity statin therapy)	16 (34%)	30 (63.8%)	0.001
Which of the following daily doses of statin therapy is considered a high-intensity statin? Correct answer (Rosuvastatin 20mg)	26 (55.3%)	35 (74.5%)	0.049
Which of the following daily doses of statin therapy is considered a moderate-intensity Statin? Correct answer (Rosuvastatin 10mg)	16 (34%)	32 (68.1%)	<0.001
Which of the following statin intensity is recommended for adult patients with clinical ASCVD such as myocardial infarction and angina? Correct answer (High-intensity statin)	27 (57.4%)	38 (80.9%)	0.027
Which of the following statin intensity is recommended for adult patients with severe primary hypercholesterolemia (LDL-C level ≥190 mg/dL [≥4.9 mmol/L])? Correct answer (High-intensity statin)	29 (61.7%)	30 (63.8%)	1.00
Which of the following statin-intensity is recommended for a 40-years old patient with only diabetes mellitus type 2 with LDL-C level of 80 mg/dL? Correct answer (Moderate-intensity statin)	25 (53.2%)	34 (72.3%)	0.049
Which of the following statin medications can be taken by patients at any time of the day? Correct answer (Atorvastatin and Rosuvastatin)	10 (21.3%)	21 (44.7%)	0.003
Which of the following statin medications does not need dose adjustment in chronic kidney disease? Correct answer (Atorvastatin)	11 (23.4%)	27 (57.4%)	<0.001
Which of the following statin medications is associated with clinically significant drug-drug interaction when used in combination with amlodipine? Correct answer (Simvastatin)	9 (19.1%)	18 (38.3%)	0.012
Which of the following statin medications is preferred to use for patients on warfarin to avoid statin-warfarin interactions? Correct answer (Atorvastatin)	9 (19.1%)	30 (63.8%)	<0.001
Which of the following statin medications is the safest to use in patients taking Clarithromycin? Correct answer (Rosuvastatin)	21 (44.7%)	33 (70.2%)	0.002
Generally, statin therapy is contraindicated in pregnancy. Correct answer (Yes)	23 (48.9%)	40 (85.1%)	<0.001
Statin therapy can be used safely during breastfeeding. Correct answer (No)	8 (17%)	26 (55.3%)	<0.001
Statin therapy is contraindicated in active liver disease. Correct answer (Yes)	23 (48.9%)	34 (72.3%)	0.019
It is recommended to assess statin efficacy by measuring LDL-C ……………… after statin therapy initiation or dose change? Correct answer (1–3 months/4-12 weeks)	12 (25.5%)	22 (46.8%)	0.013
Routine measurement for liver enzymes is not recommended during statin therapy? Correct answer (Yes)	14 (29.8%)	25 (53.2%)	0.019
Routine measurement for creatinine kinase is not recommended during statin therapy. Correct answer (Yes)	19 (40.4%)	29 (61.7%)	0.041

‎Note: ^aUsing McNemar test.

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; LDL-C, Low-density lipoprotein-cholesterol.

Table 5 The Effect of the Educational Intervention on the Improvement of Participants’ Knowledge (Categorized by Profession)

Profession		Knowledge about ASCVD risk assessment			Clinical Knowledge of statin therapy
		Median (IQR)	Z score	P-value^a	Median (IQR)	Z score	P-value^a
Physicians	Pre-intervention	4 (3–5)	−3.097	0.002	3 (1.25–6.5)	−2.938	0.003
	Post-intervention	7 (6.25–8)			9 (7.25–14.75)
Pharmacists	Pre-intervention	5 (3–5)	−2.328	0.020	8 (6–12)	−3.131	0.002
	Post-intervention	5 (5–7)			12 (9–15)
PharmD trainee	Pre-intervention	3.5 (2.25–5.75)	−2.947	0.003	6.5 (5–8.75)	−3.689	<0.001
	Post-intervention	6 (4–7)			11.5 (9.3–13.75)

Note: ^aWilcoxon signed-rank test.

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; IQR, Interquartile range.