BSPED audit of patient choice in GH therapy
J Kirk1 & S Langham2
There is now evidence that patient choice in GH device not only improves adherence with GH therapy, but in addition is associated with improved height velocity (Kapoor et al. 2008). In order to find out how common free patient choice is for those commencing GH therapy, and how choice is provided, a questionnaire was sent to all members of the BSPED.
A total of 38 questionnaires were received, including from 19 Health Services Human Growth Hormone Committee (HSHGHC) historical growth centres (Group 1), 8 other tertiary centres (Group 2), and 11 District General Hospitals (Group 3). Between them they commence 781 patients on GH a year; 595 (76%) of whom are in Group 1. Five units (all Group 1) commence more than 50 patients on GH a year.
About 35 units (92%) stated that they offer patient choice in GH device for new patients. In all but 3 units this choice is done with the nursing staff, utilising: Demonstrating the devices (N=11), Showing the patients instructional DVDs (3), Both (19), and Other (1). Many units stated that this process took in excess of 12 h.
Demonstration of devices involved: Assembling/dissembling device (32 units), Dialling up doses (31), Reconstitution of GH (27), Injecting patient (17), Injecting parent (16), Considering home nursing & other facilities provided by GH firms (17), Showing additional material (e.g. promotional, stickers etc.) (13), Consideration of cost (7). The median number of aspects shown per unit was 5 (range 28), but 6 (range 38) in Group 1.
For those units providing patient choice, devices were offered from a median of 5 manufacturers (range 27), with 11 units, 6 from Group 1, offering all.
In conclusion, the vast majority of units within the BSPED do offer some form of patient choice for new patients commencing GH therapy. This can, however, involves a variety of different methods, with the larger units, who commence over 3/4 of the new patients on GH, tending to offer more manufacturers and more aspects involved in patient choice.