The frequency of inappropriate tablet splitting in primary care.
BACKGROUND
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.


CONCLUSIONS
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.
Quinzler
R
R
Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Gasse
C
C
Schneider
A
A
Kaufmann-Kolle
P
P
Szecsenyi
J
J
Haefeli
W E
WE
D000368:Aged; D017046:Cost Savings / Q000191:economics / Q000379:methods; D003430:Cross-Sectional Studies; D004339:Drug Compounding / Q000379:methods; D004348:Drug Labeling / Q000379:methods / Q000592:standards; D011307:Drug Prescriptions / Q000191:economics; D004363:Drug Utilization / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000379:methods / Q000706:statistics & numerical data; D005858:Germany; D006801:Humans; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000191:economics; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013607:Tablets
D004364:Pharmaceutical Preparations; D013607:Tablets