ESPE Abstracts (2019) 92 P1-82

Positive Impact on Adherence Through Educational Activities of the Argentina´s Patient Support Program in Children with low Adherence to Treatment with Recombinant Growth Hormone (easypod applicator)

Aria Reza Assefi, Cinthia Chareca, Fernanda Roca, Adrian Rubstein, Luciana Celis Ayala, Cristian Von Schulz Hausmann


Merck SA, Buenos Aires, Argentina


Background: One of the main concerns in patients with growth disorders is to achieve optimal adherence to growth hormone (GH) treatment. For this it is important to identify patients with low adherence to treatment and to evaluate actions to improve it.

The Merck Patient Support Program (PSP) carried out educational actions aimed at patients with low adherence and their parents, to raise their awareness of the importance of good adherence in achieving adequate efficacy. In this study, our objective was to measure the effect of one these actions and its direct impact on the patient adherence.

Methods: This was a 12-month observational, retrospective cohort study. Adherence rate data were collected from the PSP database from April to September 2015. Patients with low adherence (<80%) who were visited after the educational visit were selected. Their adherence was measured over 6 months, before and after the educational visit.

Patient demographic data were tabulated and graphed. Statistical analyzes were carried out with the STATA 15.0 software.

Continuous variables were presented as mean and median with their respective 95% CI and categorical variables were presented as proportion with 95% CI. For an adherence comparison the "Wilcoxon sign-rank test" test was used. A multivariable linear regression was performed to assess which independent variables contribute to the variability of adherence in this population and P<0.05 was considered significant.

Results: Data from 80 patients with low adherence were analyzed. Gender distribution was 65% male, 35% female. Patients were aged between 2–18 years (mean: 11.77). The diagnoses were: Growth Hormone Deficiency 71.25%, Small for Gestational Age 20%, Turner Syndrome 7.50% and Chronic Renal Disease 1.25%. Duration of treatment was 0.4–11.13 years (mean: 4.34).

At baseline, median adherence was 67% and after the intervention it increased to 76%, a statistically significant median improvement of 9% (P=0.0000 Wilcoxon sign-rank test). Also 34% (29/80) of the patients increased their adherence to values considered as good adherence (≥80%). Both changes were clinically relevant.

No significant variables were observed in the regression model for this population.

Conclusions: Low adherence to GH therapy is multifactorial and there are few effective methods to improve adherence. We conclude that "the educational intervention" is a simple and low-cost method to improve adherence rate in patients with low adherence and recommend this type of action in these patients to reduce the gap between the indication / recommendation of the specialist and the patients' behavior.

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