Patients´Experiences of Splitting Tablets
Clinical Medicine Research
Volume 2, Issue 4, July 2013, Pages: 58-62
Received: May 16, 2013; Published: Jun. 30, 2013
Views 3037      Downloads 130
Author
B E Anders Ekedahl, Linnæus University, Kalmar, Sweden; Medical Products Agency, Uppsala, Sweden
Article Tools
PDF
Follow on us
Abstract
Objectives: To examine what patients do when they have a prescription with a dosage where tablets must be split. Methods: Interviews were performed at 12 pharmacies across Sweden with pharmacy customers who had prescriptions with a dosage meaning that the tablets have to be divided to give the prescribed individual dose. Key findings: Of the 436 pharmacy customers interviewed, 255 (58.5%) reported they divided the tablets without tools and 162 (37.2%) used tools, the most common was a knife. Only few used a tablet splitter. Almost every third patient (31.4%) stated they had problems to divide the tablets. Conclusions: Patients’ difficulties in splitting tablets are common, but seem to be overlooked. Pharmacists should be permitted to adjust dispensing to a strength corresponding to the prescribed dosage level, price policies with flat prices need to be revised to eliminate economic incentives to prescribe dosages with split tablets and a computerised decision support should be developed signalling when there is a suitable strength for the prescribed individual dose.
Keywords
Tablet Splitting; Patient Experiences; Drug Related Problem; Sweden, Community Pharmacies
To cite this article
B E Anders Ekedahl, Patients´Experiences of Splitting Tablets, Clinical Medicine Research. Vol. 2, No. 4, 2013, pp. 58-62. doi: 10.11648/j.cmr.20130204.14
References
[1]
Adherence to long-term therapies: evidence for action Geneva, Schweiz: WHO, 2003.
[2]
P. A. Atkin, T. P. Finnegan, S. J. Ogle and G. M. Shenfield. "Functional ability of patients to manage medication packaging: a survey of geriatric inpatients," Age and Ageing vol. 23, pp. 113-116, 1994.
[3]
W. Denneboom, M. G. Dautzenberg, R. Grol and P. A. De Smet. "User-related pharmaceutical care problems and factors affecting them: the importance of clinical relevance," Journal of Clinical Pharmacy and Therapeutics vol. 30, pp. 215-223, July 2005.
[4]
R. Quinzler, J. Szecsenyi and W. E. Haefeli. "Tablet splitting: patients and physicians need better support," European Journal of Clinical Pharmacology vol. 63, pp. 1203-1204, 2007.
[5]
N. Rodenhuis, P. A. De Smet and D. M. Barends. "The rationale of scored tablets as dosage form," European Journal of Pharmaceutical Sciences vol. 21, pp. 305-308, 2004.
[6]
C. Berg and A. Ekedahl. "Dosages involving splitting tablets: common but unnecessary?," Journal of pharmaceutical health services research vol. 1, pp. 137-141, 2010.
[7]
T. J. Cook, S. Edwards, C. Gyemah, M. Shah, I. Shah and T. Fox. "Variability in tablet fragment weights when splitting unscored cyclobenzaprine 10 mg tablets," Journal of the American Pharmaceutical Association vol. 44, pp. 583-586, Sep/Oct 2004.
[8]
S. W. Hill, A. S. Varker, K. Karlage and P. B. Myrdal. "Analysis of drug content and weight uniformity for half-tablets of 6 commonly split medications," J Manag Care Pharm vol. 15, pp. 253-261, April 2009.
[9]
J. T. McDevitt, A. H. Gurst and Y. Chen. "Accuracy of tablet splitting," Pharmacotherapy vol. 18, pp. 193-197, 1998.
[10]
B. T. Peek, A. Al-Achi and S. J. Coombs. "Accuracy of tablet splitting by elderly patients," The Journal of the American Medical Association vol. 288, pp. 451-452, July 2002.
[11]
J. M. Rosenberg, J. P. Nathan and F. Plakogiannis. "Weight variability of pharmacist-dispensed split tablets," Journal of the American Pharmaceutical Association (Wash) vol. 42, pp. 200-205, March/April 2002.
[12]
M. Stimpel, H. Vetter, B. Kuffer, H. Groth, P. Greminger and W. Vetter. "The scored tablet--a source of error in drug dosing?," Journal of Hypertension Suppl. vol. 3, pp. S97-99, 1985.
[13]
J. Teng, C. K. Song, R. L. Williams and J. E. Polli. "Lack of medication dose uniformity in commonly split tablets," Journal of the American Pharmaceutical Association (Wash) vol. 42, pp. 195-199, March/April 2002.
[14]
N. Rodenhuis, P. A. de Smet and D. M. Barends. "Patient experiences with the performance of tablet score lines needed for dosing," Pharmacy World and Science vol. 25, pp. 173-176, 2003.
[15]
A. Hellberg, L. Nyangen and A. Ekedahl. "Knife, scissors or razor blades...patients' experiences and problems with tablets that have to be divided [Kniv, sax eller rakblad…patienters upplevelser och problem med tabletter som måste delas]," Lakartidningen vol. 107, pp. 530-531, February 2010.
[16]
P. R. Matuschka and J. B. Graves. "Mean dose after splitting sertraline tablets," The Journal of Clinical Psychiatry vol. 62, pp. 826, October 2001.
[17]
M. Gee, N. K. Hasson, T. Hahn and R. Ryono. "Effects of a tablet-splitting program in patients taking HMG-CoA reductase inhibitors: analysis of clinical effects, patient satisfaction, compliance, and cost avoidance," Journal of Managed Care Pharmacy vol. 8, pp. 453-458, 2002.
[18]
I. Stankovic, M. Pešić and M. Lalić. "Breaking of tablets as a cost-saving strategy," Journal of Regional Section of Serbian Medical Association vol. 32, pp. 5-10, 2007.
[19]
N. G. Fawell, T. L. Cookson and S. S. Scranton. "Relationship between tablet splitting and compliance, drug acquisition cost, and patient acceptance," American Journal of Health System Pharmacy vol. 56, pp. 2542-2545, Decembre 1999.
[20]
H. M. Choe, J. G. Stevenson, D. S. Streetman, M. Heisler, C. J. Sandiford and J. D. Piette. "Impact of patient financial incentives on participation and outcomes in a statin pill-splitting program," The American Journal of Managed Care vol. 13, pp. 298-304, June 2007.
[21]
J. P. Rindone. "Evaluation of tablet-splitting in patients taking Lisinopril for hypertension," Journal of Clinical Outcomes Management vol. 7, pp. 22-24, 2000
[22]
M. C. Duncan, S. S. Castle and D. S. Streetman. "Effect of tablet splitting on serum cholesterol concentrations," The Annals of Pharmacotherapy vol. 36, pp. 205-209, February 2002.
[23]
D. Parra et al. "Effect of splitting simvastatin tablets for control of low-density lipoprotein cholesterol," The American Journal of Cardiology vol. 95, pp. 1481-1483, June 2005.
[24]
P. S. Odegard and K. Capoccia. "Medication Taking and Diabetes: A Systematic Review of the Literature," The Diabetes Educator vol. 33, pp. 1014 - 1029, November/ December 2007.
[25]
M. S. Fischbach, J. L. Gold, M. Lee, J. M. Dergal, G. M. Litner and P. A. Rochon. "Pill-splitting in a long-term care facility," Canadian Medical Association Journal vol. 164, pp. 785-786, March 2001.
[26]
R. Quinzler, C. Gasse, A. Schneider, P. Kaufmann-Kolle, J. Szecsenyi and W. E. Haefeli. "The frequency of inappropriate tablet splitting in primary care," European Journal of Clinical Pharmacology vol. 62, pp. 1065-1073, 2006.
[27]
R. Quinzler, S. P. Schmitt, M. Pritsch, J. Kaltschmidt and W. E. Haefeli. "Substantial reduction of inappropriate tablet splitting with computerised decision support: a prospective intervention study assessing potential benefit and harm," BMC Med Inform Decis Mak vol. 9, pp. 30, June 2009.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186