International Journal of Clinical Pharmacy

, Volume 35, Issue 6, pp 1130–1136 | Cite as

Swallowing difficulties with oral drugs among polypharmacy patients attending community pharmacies

  • Julien Marquis
  • Marie-Paule Schneider
  • Valérie Payot
  • Anne-Christine Cordonier
  • Olivier Bugnon
  • Kurt E. Hersberger
  • Isabelle ArnetEmail author
Research Article


Background Swallowing difficulties are common and can affect patients’ ability to take solid oral dosage forms, thus compromising medication adherence. Strategies developed by patients to overcome such difficulties while taking medicines have seldom been described. Objective To determine prevalence and characteristics of swallowing difficulties among primary care patients attending their community pharmacies; to explore strategies developed by patients to overcome their difficulties, and health professionals’ awareness of these problems. Setting Prospective study with a semi-structured questionnaire in random community pharmacies located in two Swiss regions. Method In each pharmacy, an interviewer asked 16 questions to each consecutive patient (18 years and older) with a prescription for at least 3 different solid oral forms. Main outcome measure Quantification of number of patients with swallowing difficulties and detailed description of difficulties. Results Among 122 pharmacies, 59 (48 %) accepted to join the study and 410 patients were enrolled. Thirty-seven patients (9.0 %) reported ongoing swallowing difficulties, while 55 patients (13.4 %) reported past difficulties. For the majority of patients, difficulties occurred at each single dose (83.7 %), with a single medication (59.8 %) and lasted for less than 12 months (53.8 %). Number of tablets was not the main trigger. Swallowing difficulties impaired extremely daily life in 12 % of the patients. Intentional non adherence (23 % of patients) and altering the oral dose formulation were the most common and potentially harmful strategies used by patients to overcome their swallowing difficulties. According to the patients, pharmacists and physicians rarely inquired about their swallowing difficulties. Conclusion We report a fairly high prevalence of swallowing difficulties in polypharmacy patients attending their community pharmacies. Pharmacists have to interview patients on their swallowing difficulties in a more systematic way, support patients in finding solutions and refer them to their physician if necessary to ensure continuity in care.


Community pharmacy Dysphagia History Prevalence Solid dosage forms Swallowing difficulties Switzerland 



The authors thank all the community pharmacists who took part in the study. This work was presented as a poster at the 39th European Symposium on Clinical Pharmacy ESCP, 21-23 October 2010, Lyon, France.


There was no external funding for this study.

Conflicts of interest

The authors report no conflict of interest. All named authors are responsible for the content and writing of the paper.

Supplementary material

11096_2013_9836_MOESM1_ESM.doc (38 kb)
Supplementary material 1 (DOC 37 kb)


  1. 1.
    Ekberg O, Feinberg M. Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. AJR Am J Roentgenol. 1991;156:1181–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia. 1991;6:187–92.PubMedCrossRefGoogle Scholar
  3. 3.
    Groher M, Bukatman R. The prevalence of swallowing disorders in two teaching hospitals. Dysphagia. 1986;1:3–6.CrossRefGoogle Scholar
  4. 4.
    Steele CM, Greenwood C, Ens I, Robertson C, Seidman-Carlson R. Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia. 1997;12:43–50.Google Scholar
  5. 5.
    Tordoff JM, Bagge ML, Gray AR, Campbell AJ, Norris PT. Medicine-taking practices in community-dwelling people aged ≥75 years in New Zealand. Age Ageing. 2010;39:574–80.Google Scholar
  6. 6.
    Strachan I, Greener M. Medication-related swallowing difficulties may be more common than we realise. Pharm Pract. 2005;15:411–4.Google Scholar
  7. 7.
    Schiele J, Quinzler R, Klimm H, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol. 2013;69:937–48.Google Scholar
  8. 8.
    Ware J, Snow K, Kosinski M, Gandek B. SF-36 Health Survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1993.Google Scholar
  9. 9.
    Crane HM, Rompaey SEV, Dillingham PW, Herman E, Diehr P, Kitahata MM. A single-item measure of health-related quality-of-life for HIV-infected patients in routine clinical care. AIDS Patient Care STDs. 2006;20:161–74.Google Scholar
  10. 10.
    Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the translation and cultural adaptation process for Patient-Reported Outcomes (PRO) measures: report of the ISPOR Task Force for translation and cultural adaptation. Value Health. 2005;8:94–104.Google Scholar
  11. 11.
    Andersen O, Zweidorff O, Hjelde T, Rodland E. [Problems when swallowing tablets. A questionnaire study from general practice]. Tidsskr Nor Laegeforen. 1995;115:947–9 [Article in Norwegian].PubMedGoogle Scholar
  12. 12.
    Daniel W. Biostatistics: a foundation for analysis in the health sciences. 7th ed. New York: Wiley; 1999.Google Scholar
  13. 13.
    Preston M, Morris H. Dysphagia—the impact on dispensing doctors. Dispensing Doctors’ Association (online) 2005; 21.3. Available at URL: Accessed 19 July 2011.
  14. 14.
    Wilkins T, Gillies RA, Thomas AM, Wagner PJ. The prevalence of dysphagia in primary care patients: a HamesNet research network study. J Am Board Fam Med. 2007;20:144–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Tibbling L, Gustafsson B. Dysphagia and its consequences in the elderly. Dysphagia. 1991;6:200–2.PubMedCrossRefGoogle Scholar
  16. 16.
    Arnet I, Hersberger K. Misleading score-lines on tablets: facilitated intake or fractional dosing? Swiss Med Wkly. 2010;140:105–10.PubMedGoogle Scholar
  17. 17.
    Butcher J. The Consumer Protection Act 1987 (Commencement No. 1) Order 1987, Department of Trade and Industry. Available at URL: Accessed 10 March 2013.
  18. 18.
    Morris C. Swallowing problems—how to help. Undated. Available at URL: Accessed 10 March 2013.
  19. 19.
    Chang L, Toner BB, Fukudo S, Guthrie E, Locke GR, Norton NJ, et al. Gender, age, society, culture, and the patient’s perspective in the functional gastrointestinal disorders. Gastroenterology. 2006;130:1435–46.Google Scholar
  20. 20.
    Torelli P, Abrignani G, Berzieri L, Castellini P, Ferrante T, Lambru G, et al. Population-based pace study: headache frequency and disease perception in adult subjects with headache. Neurol Sci. 2010;31:149–51.Google Scholar
  21. 21.
    WHO Expert Committee on specifications for pharmaceutical preparations. Annex 8: Good Pharmacy Practice—Joint FIP/WHO guidelines on GPP. Standards for quality of pharmacy services. Available at URL: 2011.

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Julien Marquis
    • 1
    • 2
  • Marie-Paule Schneider
    • 2
  • Valérie Payot
    • 1
  • Anne-Christine Cordonier
    • 3
  • Olivier Bugnon
    • 1
    • 2
  • Kurt E. Hersberger
    • 3
  • Isabelle Arnet
    • 3
    Email author
  1. 1.Community pharmacy, School of Pharmaceutical SciencesUniversity of Geneva, University of LausanneGenevaSwitzerland
  2. 2.Department of Ambulatory Care and Community MedicineUniversity of LausanneLausanneSwitzerland
  3. 3.Pharmaceutical Care Research Group, Pharmaceutical SciencesUniversity of BaselBaselSwitzerland

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