Tablet splitting practice among patients in Kemaman, Terengganu: An exploratory study on practical issues and their association with medication adherence.

Abstract

Introduction: The practice of tablet cutting is influenced by tablet shape and size, splitting technique, device used and human competency. Difficulties upon tablet cutting could affect patients' medication adherence, resulting in overdose or under-dose therapy. This study aimed to; 1) evaluate patients' practice in tablet cutting, 2) identify problems associated with tablet cutting, and 3) assess the association between tablet cutting related difficulties with medications adherence. Method: A cross-sectional survey was conducted among patients and caregivers aged over 18 years old, with prescription written at least one medication required to be split. Data were obtained from eight health clinics across the Kemaman district from July to September 2020. Trained pharmacists conducted face-to-face structured interviews. This study used a validated questionnaire consisting of three sections: the sociodemographic, practice of tablet cutting and medication adherence. Descriptive and non-parametric tests (SPSSv.26) were used for analysis with p<0.05 set as statistically significant. Results: The study recorded 383 returned questionnaires with a response rate of 95.8%. The most common technique used was kitchen knife (40.5%) followed by hand breaking (35.8%), scissors (12.8%) and tablet cutter (7.3%). 64.2% perceived they achieved an equal half split after cutting their medications. 25.3% claimed medication to be ruined or broken after splitting. 12.8% took the whole tablet instead of following the required dose because of splitting difficulty and 25.1% discarded parts of their tablets when splitting did not result in equal half based on their perspective. There was no association between practical problems of tablet cutting with medication adherence. Conclusion: In conclusion, knife is the most favourable tablet splitting technique but there is no consensus on the best technique for tablet splitting. In order to overcome problems encounter by patient on tablet splitting, healthcare providers should make every effort to use commercially available oral tablet if available. However, if tablet splitting is still necessary, counselling by pharmacist is compulsory to ensure quality of medication and to optimize patient’s adherence as well as medication therapy.

Keywords

• tablet cutting
• splitting technique
• medication splitting
• medication adherence