Detection and management of pill swallowing difficulties: a community pharmacy-based observational study

Swallowing difficulties with oral solid dosage forms (OSDF) are common and can lead to clinical risks, requiring early detection and management.

To determine the prevalence of swallowing difficulties with OSDF among adult pharmacy visitors, identify patient characteristics, and evaluate the success of swallowing management strategies.

In an observational study across 10 Belgian community pharmacies from March to April 2022, adults using OSDF and reporting swallowing difficulties with at least one of these OSDF were enrolled. Patients who accepted to participate completed a questionnaire detailing patient characteristics and identifying medication causing reported swallowing difficulties along with their coping strategies. Community pharmacists recommended management strategies based on the Specialist Pharmacy Service (SPS) guidance and followed up by telephone call after one week to evaluate success.

Among 3341 eligible pharmacy visitors, 197 (5.9%) reported swallowing difficulties with at least one OSDF. A total of 111 patients (mean age 57.9 ± 17.6, 79.3% female) were included, with 10.8% diagnosed with dysphagia. Few applied the recommended head forward posture (8.1%) and 54% used a sufficient amount of water. A total of 28.9% patients self-reported occasional medication skipping due to swallowing difficulties. The most common coping strategies included increased water intake (57.6%), mixing medication with food (32.1%) and modifying OSDF (28.2%). Pharmacists most often recommended proper pill swallowing technique (53.1%, 85/160) and combining correct pill swallowing technique with semi-solid food or swallowing gel (24.4%, 39/160). Follow-up revealed that 84.4% (135/160) of recommended management strategies were perceived as successful by the patients.

This study demonstrates that swallowing difficulties with OSDF are common, with a reported prevalence of 5.9%. Additionally, most patients benefited from management strategies recommended by the guidance. These findings highlight the importance of community pharmacists as gatekeepers for detecting and managing these challenges in primary care.