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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
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B E Anders Ekedahl, Linnæus University, Kalmar, Sweden; Medical Products Agency, Uppsala, Sweden
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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.
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
Adherence to long-term therapies: evidence for action Geneva, Schweiz: WHO, 2003.
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.
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.
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.
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.
C. Berg and A. Ekedahl. "Dosages involving splitting tablets: common but unnecessary?," Journal of pharmaceutical health services research vol. 1, pp. 137-141, 2010.
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.
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.
J. T. McDevitt, A. H. Gurst and Y. Chen. "Accuracy of tablet splitting," Pharmacotherapy vol. 18, pp. 193-197, 1998.
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.
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.
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.
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.
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.
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.
P. R. Matuschka and J. B. Graves. "Mean dose after splitting sertraline tablets," The Journal of Clinical Psychiatry vol. 62, pp. 826, October 2001.
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.
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.
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.
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.
J. P. Rindone. "Evaluation of tablet-splitting in patients taking Lisinopril for hypertension," Journal of Clinical Outcomes Management vol. 7, pp. 22-24, 2000
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.
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.
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.
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.
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.
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.
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