Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
Department of Computer Science, University of Manchester, Manchester, United Kingdom.
Front Endocrinol (Lausanne). 2023 May 31;14:1167854. doi: 10.3389/fendo.2023.1167854. eCollection 2023.
Easypod-connect™ for childhood growth disorders is a unique connected system that enables transmission of injection adherence information for recombinant human growth hormone (r-hGH). Although this system has the potential to facilitate greater adherence, observational studies have shown declining adherence over prolonged periods when used without additional support. Supplemental nurse practitioner support has been envisaged but not investigated; in this study, we have undertaken feasibility analysis of nurse-led virtual reviews (NVR) in combination with easypod-connect™ in a single centre using quantitative and qualitative analyses.
We aimed to test feasibility by assessing compliance with NVR, height standard deviation score (SDS) gain, adherence improvement and patient opinions.
Patients using easypod™ r-hGH were recruited prospectively to a 12-month study with two telephone NVR appointments in addition to standard of care in-person hospital outpatient visits. A subset was recruited for a semi-structured interview for qualitative thematic analysis.
Forty-three patients of median (range) age 10.7 (6.7, 15.2) were recruited for a period of 1.1 (0.7, 1.8) years. Thirty-three (76.7%) patients were fully compliant with NVR integration with easypod-connect™, establishing feasibility. Median (inter-quartile range, IQR) height SDS improved from -1.85 (-2.44, -1.37) to -1.48 (-2.14, -1.07) (p<0.001) while adherence remained similar in the majority from study start [96.5 (88.8, 100.0)] to end [99.0 (94.0, 100.0)]. Qualitative analysis identified themes supporting patient benefit: practicalities of appointments, perceived purpose and significance of virtual reviews, and the importance of optimising growth. Four patients complained of injection pain, of whom two switched to an alternative r-hGH device.
Our study has demonstrated the feasibility of nurse-led virtual review integration with easypod-connect™ in a mixed methods study, laying the foundation for research in larger groups over longer periods. Nurse practitioner supported application of easypod-connect™ offers the potential for improved growth outcomes in all r-hGH devices providing adherence information.
Easypod-connect™ 适用于儿童生长障碍，是一种独特的连接系统，可传输重组人生长激素（r-hGH）的注射依从性信息。尽管该系统有可能提高患者的依从性，但观察性研究表明，在没有额外支持的情况下，长期使用时依从性会逐渐下降。人们已经设想了补充执业护士的支持，但尚未进行研究；在这项研究中，我们使用定量和定性分析，在一个中心对护士主导的虚拟评估（NVR）与 easypod-connect™ 联合使用进行了可行性分析。
通过评估对 NVR 的依从性、身高标准差评分（SDS）的增加、依从性的改善和患者的意见，我们旨在测试可行性。
前瞻性地招募了使用 easypod™ r-hGH 的患者，进行了为期 12 个月的研究，除了标准的门诊就诊外，还增加了两次电话 NVR 预约。一小部分患者还接受了半结构化访谈，进行定性主题分析。
43 名年龄中位数（范围）为 10.7 岁（6.7-15.2 岁）的患者被招募，研究时间为 1.1 年（0.7-1.8 年）。33 名（76.7%）患者完全遵守了 easypod-connect™ 与 NVR 的整合，从而确立了可行性。身高 SDS 的中位数（四分位距，IQR）从-1.85（-2.44，-1.37）改善至-1.48（-2.14，-1.07）（p<0.001），而大多数患者从研究开始时的依从性[96.5（88.8，100.0）]到结束时[99.0（94.0，100.0）]保持相似。定性分析确定了支持患者获益的主题：预约的实际情况、虚拟评估的感知目的和意义、以及优化生长的重要性。有 4 名患者抱怨注射疼痛，其中 2 名患者改用了另一种 r-hGH 设备。
我们的研究在混合方法研究中证明了护士主导的虚拟审查与 easypod-connect™ 整合的可行性，为在更大群组中进行更长时间的研究奠定了基础。在所有提供依从性信息的 r-hGH 设备中，执业护士支持 easypod-connect™ 的应用有可能改善生长结果。
