Growth hormone (GH) stimulates growth and cell reproduction in humans and other animals. GH has a variety of functions in the body, the most noticeable of which is the increase of height throughout childhood and in the treatment of several diseases. Rosenfeld and Bakker sought to identify key factors that influence compliance and persistence in patients receiving GH therapy and to promote the development of interventions to support continuous GH use. A 134-question survey was given to 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. On the basis of their responses to questions about reasons for missing GH doses, patients were categorized by level of compliance into three 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 three 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.

WHAT THE STUDY MAY MEAN TO YOU: The authors concluded that education should emphasize therapeutic end points and their relationship to compliance with GH therapy. This, in turn, might convince and empower patients with GH deficiency to use self-care strategies to achieve their treatment goals. As GH therapy is expensive--it has been estimated that it would cost about $40 billion dollars to treat the estimated 400,000 American children ages 4 to 15 who are now eligible for growth hormone therapy in the United States--adherence to a GH regimen is a necessity both for practical and economic reasons. Here's where a self-management program for controlling GH therapy could be a boon.

RG Rosenfeld, B Bakker. Compliance and persistence in pediatric and adult patients receiving growth hormone therapy. Endocrine Practice, 2008;14:143-154.