Evaluation of Patient’s Knowledge of Atorvastatin Information in Patient Information Leaflets: A Pre-Post Intervention Study in Thailand

Figures & data

Table 1 Percentage of Respondents Giving Correct Answers to Atorvastatin Knowledge at Baseline and at 1-Month

Question	Correct Answer	Number of Respondents Who Answered Correctly (N= 370)
		Pre-test N (%)	Post-test N (%)	Change N (%)
Q1: What is generic name of this medicine?	Atorvastatin	143(38.6)	331(89.5)	+188 (50.9)
Q2: What is indication of this medicine?	Decrease blood cholesterol	295(79.7)	352(95.1)	+57 (15.4)
Q3: What is contraindication of this medicine?	Hepatic disease	122(33.0)	315(85.1)	+193 (52.1)
Q4: Can pregnant and breastfeeding women take this medicine?	No	248(67.0)	354(95.7)	+106 (28.7)
Q5: How should you take this medicine?	Take it at the same time every day	261(70.5)	333(90.0)	+72 (19.5)
Q6: What should you do if you miss a dose?	Take as soon as you remember, or with a next dose	291(78.6)	350(94.6)	+59 (16.0)
Q7: What symptoms should stop you taking the medicine and go to the doctor?	Muscle pain and fever with unknown cause	139(37.6)	137(37.0)	−2 (0.6)
Q8: How should you keep this medicine?	Keep this medicine under 30°C	253(68.4)	341(92.2)	+88 (23.8)
Q9: What organ should be checked after receiving this medicine for 6 and 12 weeks and every 6 months?	Liver	86(23.2)	294(79.5)	+208 (56.3)
Q10: How does this medicine affect sugar levels?	An increase of blood sugar	36(9.7)	277(74.9)	+241 (65.2)
Total mean score (Mean ± S.D.)		5.06±1.92	8.34±1.79	3.27±2.24
Median (IQR)		5 (4–6)	9 (8–9)	p<0.001^a

Notes: ^aPaired samples t-test was used to compare atorvastatin knowledge score between pre-test and post-test. Bold value indicates statistical significance at p- value<0.05.

Abbreviations: N, number of respondents; IQR, interquartile range.

Figure 1 Atorvastatin knowledge between pre-test and post-test categorized by a passing score at ≥ 8 points.

Table 2 Comparison of Factors Affecting Pre-Test, Post-Test and Mean Difference of Atorvastatin Knowledge Score

	N	Pre-test Score		Post-test Score		Mean Difference
		Mean±SD	p-value	Mean±SD	p-value	Mean±SD	p-value
Gender (n=370)
Male	231	4.95±1.91	0.131^a	8.25±1.86	0.272^c	3.30±2.26	0.717^a
Female	139	5.26±1.92		8.47±1.67		3.22±2.22
Age (n=370)
< 45	22	5.82±1.56	0.058^b	8.68±1.73	0.327^d	2.86±2.03	0.639^b
45–60	204	5.14±1.93		8.40±1.71		3.26±2.33
> 60	144	4.84±1.93		8.19±1.92		3.35±2.15
Education level (n=369)
Primary school	129	4.43±2.00	<0.001^b	7.65±2.21	<0.001^d	3.22±2.74	0.729^b
High school	86	4.92±1.58		8.35±1.71		3.43±1.88
Bachelor’s degree or higher	154	5.71±1.79		8.92±1.13		3.20±1.95
Careers (n=369)
None and students	28	3.93±1.80	<0.001^b	8.14±2.07	<0.001^d	4.21±2.39	0.051^b
Agriculturists	111	4.78±1.81		7.73±2.09		2.95±2.54
Business employees	61	4.70±2.12		7.85±2.17		3.15±2.30
Civil servants	169	5.60±1.75		8.95±1.05		3.36±1.93
Underlying diseases (n=370)
1	214	4.90±1.95	0.056^a	8.22±1.89	0.076^c	3.32±2.28	0.601^a
> 1	156	5.29±1.86		8.49±1.66		3.20±2.20
Concomitant drugs (n=365)
< 3	40	5.33±2.08	0.527^b	8.88±1.45	0.006^d	3.55±2.07	0.527^b
3–5	163	5.11±1.80		8.42±1.73		3.31±2.04
> 5	162	4.96±2.00		8.09±1.92		3.13±2.46
Duration of atorvastatin therapy (n=364)
< 1 year	107	5.22±1.91	0.306^a	8.01±2.11	0.116^c	2.79±2.45	0.009^a
≥ 1 years	257	5.00±1.90		8.46±1.63		3.46±2.14
Using herbs (n=370)
No	316	5.07±1.94	0.969^a	8.24±1.86	0.015^c	3.18±2.28	0.053^a
Yes	54	5.06±1.77		8.87±1.24		3.81±1.90
Previous experience of allergy (n=370)
No	343	5.08±1.86	0.707^a	8.38±1.77	0.085^c	3.30±2.21	0.359^a
Yes	27	4.89±2.55		7.78±2.06		2.89±2.67
Reading behavior to current PILs (n=362)
Read all sections	136	5.48±1.90	0.002^a	8.82±1.25	0.001^c	3.27±2.29	0.740^a
Read some sections	226	4.84±1.91		8.10±1.92		3.35±2.10

Notes: ^aIndependent samples t-test was used to compare difference in knowledge score between two categories. ^bOne way ANOVA was used to compare difference in knowledge score between three categories or more. ^cMann–Whitney test ^dKruskal–Wallis Test. Bold values indicate statistical significance at p-value <0.05.

Abbreviations: PILs, patient information leaflets; N, number of respondents.

Table 3 Adjusted Linear Regression for Atorvastatin Knowledge at Pre-Test, Post-Test, and Change in Knowledge Score

Factor	b	SEb	β	t	95% Confidence Interval		p-value
					Lower	Upper
Pre-test score*
Primary school grade	−1.593	0.290	−0.395	−5.500	−2.162	−1.023	<0.001
High school grade	−0.803	0.260	−0.175	−3.082	−1.315	−0.290	0.002
Read PILs for all contents	0.481	0.201	0.121	2.395	0.086	0.875	0.017
Agriculturists	0.595	0.274	0.142	2.172	0.056	1.133	0.031
	Constant 5.459; SEest = ± 1.82782
	R = 0.331; Adjusted R^2 = 0.100; F = 11.010; p-value = <0.0001
Post-test score**
Civil servants	0.973	0.176	0.280	5.520	0.626	1.320	<0.001
Read PILs for all contents	0.503	0.181	0.141	2.774	0.146	0.859	0.006
Previous experience of allergy	−0.667	0.326	−0.101	−2.046	−1.309	−0.026	0.042
	Constant 7.883; SEest = ± 1.63
	R = 0.353; Adjusted R^2 = 0.117; F = 16.985; p-value = <0.0001
Mean difference***
Use the medicine at least 1 year	0.631	0.251	0.130	2.513	0.137	1.125	0.012
	Constant 0.130; SEest = ± 2.22492
	R = 0.130; Adjusted R^2 = 0.017; F = 6.317; p-value = 0.012

Notes: b denotes the variable estimate, SE_b denotes the standard error of the variable estimate, β denotes the standardized estimate, a denotes adjust pre-test mean score variable. *Adjusted for gender, age, underlying disease. **Adjusted for gender, underlying disease, concomitant drugs, using herbs. ***Adjusted for career, using herbs. Bold value indicates statistical significance at p-value <0.05.

Table 4 Factors Associated with PIL Benefit Scores and Patients’ Anxious Scores (Multiple Linear Regression)

Factor	b	SEb	β	T	95% Confidence Interval		p-value
					Lower	Upper
PIL benefit score
Read all of the PIL	0.533	0.198	0.142	2.696	0.144	0.923	0.007
Concomitant medications > 5	− 0.491	0.194	−0.133	−2.533	−0.872	−0.110	0.012
	Constant 8.877; SEest = ± 1.79353
	R = 0.204; Adjusted R^2 = 0.036; F = 7.615; p-value = 0.001
Anxiety score after reading the PILs
Female	1.375	0.329	0.219	4.175	0.727	2.023	<0.001
Herbal user	0.906	0.456	0.104	1.986	0.009	1.803	0.048
	Constant 3.022; SEest = ± 2.97637
	R = 0.248; Adjusted R^2 = 0.056; F = 11.232; p-value <0.001

Notes: b denotes the variable estimate, SE_b denotes the standard error of the variable estimate, β denotes the standardized estimate. All factors with p<0.20 from the univariate analysis were included in the multiple linear regression analysis. Bold value indicates statistical significance at p-value <0.05.