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The frequency of inappropriate tablet splitting in primary care

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Abstract

Introduction

We assessed the frequency and determinants of tablet splitting in primary care in Germany and evaluated the quality of information on divisibility in the Summary of Product Characteristics (SPCs) and in the Package Leaflet (PL) as legal sources of information for health care providers and patients.

Methods

We performed a cross-sectional questionnaire survey among patients of 59 general practitioners in the German Federal State Saxony-Anhalt in 2005 in order to collect detailed information on all drugs of patients maintained on more than three drugs.

Results

The response rate was 82.1% (n=905) and 3,158 drugs (tablets and dragées) were included in the analyses. Of all drugs, 24.1% were split (762 of 3,158): 8.7% of all split tablets were unscored (66 of 762) and 3.8% of all split tablets were not allowed to be split (29 of 762). Tablets of the higher price categories and higher strengths were twice as likely to be split. Only 22.5% of the SPCs (9 of 40) of the split unscored tablet brands contained explicit information on divisibility and only 36.4% of the PLs (8 of 22) of the split brands that were not allowed to be split stated that splitting was not appropriate.

Conclusion

The splitting of tablets in primary care is a frequent habit likely driven by medical and economic considerations. Almost 1% of all tablets are split that must not be fragmented. However, the SPC and PL provide only limited information on divisibility stressing the need to improve this information promptly to avoid medication errors.

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Acknowledgements

This study is part of a larger quality improvement project, which is supported by grant No. 217-43794-6/8 from the German Ministry of Health and Social Security. We are grateful to the participating GPs in Saxony-Anhalt who helped us to perform a questionnaire survey with a good response rate.

Author information

Correspondence to W. E. Haefeli.

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Quinzler, R., Gasse, C., Schneider, A. et al. The frequency of inappropriate tablet splitting in primary care. Eur J Clin Pharmacol 62, 1065–1073 (2006) doi:10.1007/s00228-006-0202-3

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Keywords

  • Package leaflet
  • Summary of product characteristics
  • Survey
  • Tablet splitting