Community pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
Int J Clin Pharm. 2013 Dec;35(6):1130-6. doi: 10.1007/s11096-013-9836-2. Epub 2013 Aug 21.
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.
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.
Prospective study with a semi-structured questionnaire in random community pharmacies located in two Swiss regions.
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.
Quantification of number of patients with swallowing difficulties and detailed description of difficulties.
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.
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.
吞咽困难很常见，会影响患者服用固体口服剂型的能力，从而影响药物依从性。患者为克服服药困难而采取的策略很少有文献描述。
确定在社区药房就诊的初级保健患者吞咽困难的发生率和特点；探讨患者克服困难的策略，以及卫生保健专业人员对这些问题的认识。
在瑞士两个地区的随机社区药房进行前瞻性研究，采用半结构式问卷。
在每个药房，访视员向每一位连续的患者（18 岁及以上）询问 16 个问题，这些患者至少有 3 种不同的固体口服剂型的处方。
吞咽困难患者的数量和困难程度的详细描述。
在 122 家药房中，有 59 家（48%）同意参与研究，共纳入 410 名患者。37 名患者（9.0%）报告正在经历吞咽困难，55 名患者（13.4%）报告过去曾经历过吞咽困难。对于大多数患者来说，困难发生在每次单一剂量时（83.7%），仅服用一种药物（59.8%），持续时间不到 12 个月（53.8%）。服用药物的片数不是主要诱因。吞咽困难极大地影响了 12%患者的日常生活。故意不遵医嘱（23%的患者）和改变口服剂型是患者克服吞咽困难最常用和潜在有害的策略。根据患者的说法，药剂师和医生很少询问他们的吞咽困难。
我们报告了在社区药房就诊的多药治疗患者中吞咽困难的发生率相当高。药剂师必须以更系统的方式询问患者的吞咽困难情况，为患者找到解决方案提供支持，如果有必要，将患者转介给医生，以确保治疗的连续性。
