Pill Properties that Cause Dysphagia and Treatment Failure.
Pill Properties that Cause Dysphagia and Treatment Failure.
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DOI：
10.1016/j.curtheres.2015.08.002
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Schulze KS
中科院分区：
文献类型：
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作者：
Fields J;Go JT;Schulze KS
药丸(片剂和胶囊)被广泛用于服用处方药或服用维生素等补充剂。不幸的是，很少有人知道美国人需要多大的努力才能吞下这些不同的药片。更具体地说，目前还不知道难以下咽的药片会在多大程度上影响治疗结果(例如，干扰对处方药物的坚持或导致临床并发症)。也不清楚美国人喜欢还是不喜欢哪些特性(例如，大小、形状或表面纹理)来制作药丸。为了更多地了解这些问题，我们采访了一小群人。我们邀请了我们三级卫生保健中心候诊室的个人参加结构化访谈，了解他们的服药习惯以及他们在吞咽药物方面的任何问题。我们询问了他们认为是哪些药片特性导致了吞咽问题。参与者对具有代表性的大小、形状和质地的胶囊和药丸进行评分，以进行吞咽，并报告他们的个人偏好。在100名连续的个人中，99名参与者完成了采访(65%是女性，平均年龄为41岁，范围为23-77岁)。83%的人每天服药(平均每天4片；其中56%的药片是由提供者开的)。54%的受试者对这个问题的回答是肯定的：“你是否曾经吞下过太难的固体药物？”4%的人描述了严重的并发症：1%的药丸食管炎，1%的药丸嵌塞，2%的人因为不能吞咽处方的药片而停止治疗(抗生素和产前补充剂)。所有参与者中有一半经常求助于特殊的技巧(例如，大量的液体或重复或强力的吞咽)。有困难的人中有61%的人提到了特定的药丸特性：27%的人归咎于药丸的大小(20%的问题是由药丸太大引起的，7%的人抱怨药丸太小而感觉不到)；12%的人认为是表面粗糙的质地；其他人则认为是边缘尖锐、形状奇怪或味道/气味不好。人们普遍厌恶超大药片，五分之四的参与者更愿意服用三片或更多中等尺寸的药片，而不是一颗巨型药片。我们的调查结果表明，五分之四的美国成年人每天吃几片药，而且不费力气。它还表明，今天有一半的美国人会遇到难以下咽的药片。多达4%的参与者放弃了治疗，因为他们不能吞下开出的药片。高达7%的人断然拒绝服用难以下咽的药片。人们普遍认为，特殊的材料特性导致药丸难以下咽；人们普遍担心超大胶囊和片剂，而包衣光滑的中型药丸则普遍受到青睐。我们的发现表明，医疗保健提供者可以通过开出和分发容易吞咽的药片来最大限度地减少治疗失败和并发症。工业和监管机构可以通过使吞咽能力成为口服药物设计和许可的基本标准来促进这一点。这样的政策可以减轻美国人服药的负担，并提高对处方治疗的依从性。
Pills (tablets and capsules) are widely used to administer prescription drugs or to take supplements such as vitamins. Unfortunately, little is known about how much effort it takes Americans to swallow these various pills. More specifically, it is not known to what extent hard-to-swallow pills might affect treatment outcomes (eg, interfering with adherence to prescribed medications or causing clinical complications). It is also unclear which properties (eg, size, shape, or surface texture) Americans prefer or reject for their pills. To learn more about these issues, we interviewed a small group of individuals. We invited individuals in waiting rooms of our tertiary health care center to participate in structured interviews about their pill-taking habits and any problems they have swallowing pills. We inquired which pill properties they believed caused swallowing problems. Participants scored capsules and pills of representative size, shape, and texture for swallowing effort and reported their personal preferences. Of 100 successive individuals, 99 participants completed the interview (65% women, mean age = 41 years, range = 23-77 years). Eighty-three percent took pills daily (mean 4 pills/d; 56% of those pills were prescribed by providers). Fifty-four percent of participants replied yes to the question, "Did you ever have to swallow a solid medication that was too difficult?" Four percent recounted serious complications: 1% pill esophagitis, 1% pill impaction, and 2% stopped treatments (antibiotic and prenatal supplement) because they could not swallow the prescribed pills. Half of all participants routinely resorted to special techniques (eg, plenty of liquids or repeated or forceful swallows). Sixty-one percent of those having difficulties cited specific pill properties: 27% blamed size (20% of problems were caused by pills that were too large whereas 7% complained about pills that were too small to sense); 12% faulted rough surface texture; others cited sharp edges, odd shapes, or bad taste/smell. Extra-large pills were widely loathed, with 4 out of 5 participants preferring to take 3 or more medium-sized pills instead of a single jumbo pill. Our survey results suggest that 4 out of 5 adult Americans take several pills daily, and do so without undue effort. It also suggests that half of today’s Americans encounter pills that are hard to swallow. Up to 4% of our participants gave up on treatments because they could not swallow the prescribed pills. Up to 7% categorically rejected taking pills that are hard to swallow. Specific material properties are widely blamed for making pills hard to swallow; extra-large capsules and tablets are universally feared, whereas medium-sized pills with a smooth coating are widely preferred. Our findings suggest that health care providers could minimize treatment failures and complications by prescribing and dispensing pills that are easy to swallow. Industry and regulatory bodies may facilitate this by making swallowability an essential criterion in the design and licensing of oral medications. Such policies could lessen the burden of pill taking for Americans and improve the adherence with prescribed treatments.