Guidelines for the use of Growth Hormone (GH) replacement in adults with GH deficiency (GHD) were published by the National Institute for Clinical Excellence (NICE) in 2003. We undertook an audit to ensure that patients attending our adult endocrinology clinic were being prescribed GH in accordance with NICE guidelines.
Patients commenced on GH replacement between June 2004 and June 2005 were included in the audit. Data was collected from medical notes, and was compared to the 6 NICE standards.
25 patients had a biochemical diagnosis of GHD, however 5 of these had an AGDHA score of <11. 19 patients fulfilled NICE criteria for GH replacement, 2 of whom had childhood onset GHD. The average time taken to receive written approval from GPs was 110±24 days. Patients then waited a further 48±9 (mean ± S.E.M.) days before starting GH.
Results are shown as the number fulfilling NICE criteria/total number of patients within each standard. S1- biochemical diagnosis of GHDA, AGHDA score >11 and other pituitary hormone deficiencies (15/17); S2-improvement of 7 points in AGHDA score after a 9 month trial period (13/13); S3-reassessment of patients with childhood onset of GH (once achieved linear growth/peak bone mass)(1/2); S4-as for S3 but applying to patients in early adulthood (1/1); S5-Clinical care is undertaken by a consultant endocrinologist (19/19); S6- Primary care involvement via agreed shared care protocol (10/10).
Our practice shows good adherence to NICE guidelines. The unexpected delay in the time taken to start GH incorporates time taken for patient education. No GPs refused to prescribe GH, however this does not reflect more recent experience. One GP prescribed GH outside NICE guidelines. These data demonstrate the reliance on AGHDA score which may penalise patients who benefit from GH in other ways such as protection against cardiovascular risk, and maintenance of bone density.