Compliance and persistence in pediatric and adult patients receiving growth hormone therapy.

OBJECTIVE: To identify key factors that influence compliance and persistence in patients receiving growth hormone (GH) therapy and to promote the development of interventions to support continuous GH use.
METHODS: A 134-question survey was conducted involving 158 adult patients, 326 adolescents or teens, and 398 parents of children currently receiving or previously treated with GH. Questions explored perceptions about GH deficiency and treatment outcomes, quality of training received for administration of injections, and disruptions affecting compliance and persistence with therapy. Compliance was defined by a categorical assessment of frequency of missed GH doses for specific reasons. Persistence was defined as continuing GH therapy with no interruption.
RESULTS: On the basis of their responses to questions about potential reasons for missing GH doses, patients were categorized by level of compliance into 3 segments--highly compliant, occasionally noncompliant, or noncompliant and skeptical. Noncompliance with GH therapy (that is, classification in one of the last 2 segments) ranged from 64% to 77% among the 3 age-groups evaluated, with teens having the highest rate of noncompliance. Misperceptions about the consequences of missed GH doses, discomfort with injections, dissatisfaction with treatment results, and inadequate contact with health-care providers (along with other factors) were strongly associated with noncompliance. Survey questions related to these factors were considered useful for identifying patients requiring additional support or intervention to improve compliance.
CONCLUSION: Routine education should emphasize therapeutic end points and their relationship to compliance with GH therapy in an effort to convince and empower patients with GH deficiency to use self-care strategies to achieve their treatment goals.