ESPE Abstracts

Introduction: Easypod-connect™ for childhood growth disorders is a unique connected system that enables the 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 a feasibility analysis of nurse-led virtual reviews (NVR) in combination with easypod-connect™ in a single centre using quantitative and qualitative analyses.

Methods: We aimed to explore 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.

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 fully complied 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) and was negatively correlated with prior length of r-hGH treatment (r= -0.34, P=0.029) but not influenced by the presence of confirmed growth hormone deficiency. Adherence was high at study start and remained similar in the majority from study start [96.5 (88.8, 100.0)] to end [99.0 (94.0, 100.0)], in contrast with other observational studies lacking NVR. 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; 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 practitioners supported the application of easypod-connect™ maintained adherence throughout the study period and offers the potential for improved growth outcomes in all r-hGH devices providing adherence information.