Adherence to growth hormone therapy in children and its potential barriers

Abstract

Background: One of the main concerns in chronic diseases such as growth hormone (GH) deficiency is adherence to the treatment, which significantly affects treatment outcomes. Methods: This cross-sectional study was conducted among 169 GH recipient children (2-12 years) and teens (13-19 years) referred to a GH distributing teaching pharmacy. The eight-item Morisky Medication Adherence Scale (MMAS) and auto-compliance method were used for the assessment of patients' adherence to GH. The potential barriers to GH therapy adherence and medication persistence were also explored. Results: Based on the MMAS method, 56.7% of the children and 57.9% of the adolescent groups were adherent to GH therapy. Conversely, according to the auto-compliance method almost all the patients were adherent in the children (95.2%) and adolescent (95.5%) groups. Forgetting to take the injection or refill the prescription, being away from home, exhaustion from long-term injection, drug shortage and inaccessibility to the pharmacy were barriers found to be significantly associated with a low adherence in the children group. While in the adolescent group, forgetting to take the injection, painful injection, concern about longterm complications and exhaustion from long-term injection revealed a significant association with low adherence. Persistence with GH therapy was reported in 75.3% and 67% of children and adolescent patients, respectively.

Identifying Potentially Modifiable Factors Associated with Treatment Non-Adherence in Paediatric Growth Hormone Deficiency: A Systematic Review

“…The full study selection process is illustrated in online supplementary Figure 1 (full reasons for exclusion are detailed in online suppl. Table 5 [10, 15, 24-30, 33-38]).…”

“…Factors unique to the wider literature included: fear of side effects/long-term complications [15, 27, 35], the preference [36] and convenience of an injection device (ease of use, technical handling, and storage) [10, 24, 36], and accessibility of the rhGH distributing pharmacy [15] as well as sociodemographic factors (more specifically, the level of parental school education) [24, 29, 34, 38]. …”

“…Relevant full-text studies were collated and evaluated for eligibility for inclusion (online suppl. Table 4 [2, 3, 10, 12, 15, 17, 24-38]). Co-authors (V.A.…”

“…Studies that did not fulfil the criteria were omitted throughout the process, with accompanying reasons for exclusion (online suppl. Table 5 [10, 15, 24-30, 33-38]). A PRISMA flow chart outlining the full study selection process is presented in online supplementary Figure 1.…”

Growth and growth hormone: recent papers on efficacy and adverse effects of growth hormone and World Health Organisation growth standards

“…In a study from Iran by Mohseni et al [3], the authors have evaluated adherence to GH therapy in 169 children between the ages of 2 and 19 years based on a questionnaire, the quality of which was tested before the study. The 8-item Morisky Medication Adherence Scale (MMAS) was used for the assessment of patients' adherence and auto-compliance method as described in the paper.…”