Mohseni Shahrzad, Heydari Zahra, Qorbani Mostafa, Radfar Mania
Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Faculty of Pharmacy, Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Endocrinol Metab. 2018 Jan 26;31(1):13-20. doi: 10.1515/jpem-2017-0157.
One of the main concerns in chronic diseases such as growth hormone (GH) deficiency is adherence to the treatment, which significantly affects treatment outcomes.
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.
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 long-term 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.
The current study revealed that overall adherence of the study population is low. Considering the barriers with significant association with adherence, different strategies can be incorporated to enhance adherence to GH therapy, i.e. providing early patient and parent education and support, medication reminder systems and longer duration of GH prescriptions.
在诸如生长激素（GH）缺乏症等慢性疾病中，主要关注点之一是治疗依从性，这会显著影响治疗效果。
本横断面研究在转诊至一家分发生长激素的教学药房的169名接受生长激素治疗的儿童（2至12岁）和青少年（13至19岁）中进行。采用八项Morisky药物依从性量表（MMAS）和自动依从性方法来评估患者对生长激素的依从性。还探讨了生长激素治疗依从性和药物持续性的潜在障碍。
基于MMAS方法，儿童组中56.7%的儿童和青少年组中57.9%的青少年依从生长激素治疗。相反，根据自动依从性方法，儿童组（95.2%）和青少年组（95.5%）几乎所有患者都依从治疗。在儿童组中，忘记注射或重新开药、离家在外、长期注射导致的疲惫、药物短缺以及无法到达药房被发现与低依从性显著相关。而在青少年组中，忘记注射、注射疼痛、对长期并发症的担忧以及长期注射导致的疲惫与低依从性显著相关。分别有75.3%的儿童患者和67%的青少年患者持续接受生长激素治疗。
当前研究表明，研究人群的总体依从性较低。考虑到与依从性显著相关的障碍，可以采用不同策略来提高对生长激素治疗的依从性，即提供早期的患者和家长教育及支持、药物提醒系统以及延长生长激素处方的时长。
