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. 2023 May 31:14:1167854.
doi: 10.3389/fendo.2023.1167854. eCollection 2023.

Integration of nurse-led virtual reviews with growth hormone device-linked patient adherence information: a mixed methods feasibility study

Helen Stokes  1 , Julie Jones  1 , Chris Worth  1   2 , Jacqueline Nicholson  3 , Catherine Fullwood  4   5 , Indraneel Banerjee  1   6
Affiliations

Integration of nurse-led virtual reviews with growth hormone device-linked patient adherence information: a mixed methods feasibility study

Helen Stokes et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: 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.

Aims: We aimed to test feasibility by assessing compliance with NVR, height standard deviation score (SDS) gain, adherence improvement and patient opinions.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: adherence; children; growth hormone; growth hormone device; nurse-led; short stature.

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Conflict of interest statement

IB is the Associate Medical Director for Research and Innovation at the Royal Manchester Children’s Hospital and is on the advisory boards of NICE Head Injury guidelines, Pituitary Foundation, Living with CAH, Congenital Hyperinsulinism Charity UK and Congenital Hyperinsulinism International Committee. He is the Chair of the European Society for Paediatric Endocrinology Communications Committee, Chair of NIHR British Society of Paediatric Endocrinology and Diabetes BSPED Clinical Studies Group and Treasurer, Manchester Medical Society. IB has received grant support from Merck, Zealand Pharma, Crinetics and Dexcom, and honoraria from Merck advisory board and project design. He does not own direct shares or equities in Merck, Zealand Pharma, Crinetics or Dexcom. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pictorial description of study plan per patient. NVR = nurse-led virtual review conducted over a telephone call, A1 = in person appointment in hospital at the start of the study, A2 = in person appointment in hospital at the end of the study, AW = adherence window.
Figure 2
Figure 2
Flowchart of patients recruited to the study showing frequency of compliance with nurse-led virtual review (NVR). GHD, growth hormone deficiency; SGA, small for gestational age; TS, Turner syndrome; SHOX, short stature homeobox containing gene deficiency; CRF, chronic renal failure.
Figure 3
Figure 3
Box and whisker plot showing height SDS at the start (white boxes) and end (lilac boxes) of the study for fully compliant (2 reviews) or incompletely compliant (<2 reviews) nurse-led virtual reviews (NVR).
See this image and copyright information in PMC

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