Relationship between tablet splitting and compliance, drug acquisition cost, and patient acceptance.

As managed care pharmacy continues to grow and medication costs increase, pharmacy managers are continually looking for ways to reengineer distributive services to provide the most cost-effective care. In an effort to save money, the San Diego Veterans Affairs Healthcare System (SDVAHS) and other health systems have implemented tablet-splitting programs targeted at high-cost and widely prescribed medications. Despite this growing practice, published research examining the effects on compliance rates, patient acceptance, and actual cost savings is lacking. A recent computer-assisted literature search revealed only one study of tablet splitting that addressed patient compliance and acceptance. In that study, patients taking lovastatin and using a tablet splitter were mailed a questionnaire to assess their impressions of tablet splitting. A majority of the patients found tablet splitters easy to use and reported that compliance was not hindered. However, compliance was subjectively evaluated through patients' responses to questions; actual tablet counts were not performed. Furthermore, actual cost savings (if any) were not determined.