Evolution of Growth Hormone Devices
Allowing patients to choose a delivery device has been associated with better treatment adherence (Kapoor et al., 2008). Ideally, nursing staff familiar with GH devices can assist patients with selection of the GH device best matched to the patient's preferences and needs to maximize treatment tolerability and adherence. Through discussion with the patient and his or her caregivers, nursing staff can learn what device characteristics may make taking daily GH most acceptable and maximize adherence. For example, if the patient fears needles, use of a needle cover or a needle-free device is recommended. Or, if anyone in the patient's household is an intravenous drug user, a needle-free device is recommended. Although selection of the GH device may be determined by the patient's health insurance company formulary guidelines, nursing staff with experience with GH devices can play an essential role in patient education and training in the use of the selected device. Education and training may include device demonstrations, instructional DVDs, product literature, and discussion of the strengths and limitations of the device.
Coaching and support, as well as guidance to parents, provided by nursing staff following device selection are critical to achieve optimal treatment adherence. The patienthealth care provider relationship is key to maximizing adherence (Haverkamp et al., 2008). Possible contributing factors for low adherence that should be addressed with education include the patient's lack of understanding of the disease, optimal treatment, and likely suboptimal outcomes associated with decreased adherence (Rosenfeld & Bakker, 2008; Smith, Hindmarsh, & Brook, 1993). To improve treatment adherence, user-friendly injection pens or needlefree devices (see Table 2) should be selected to prioritize ease of use for self-injection by children. Additionally, it is the experience of the authors that minimal reconstitution and storage requirements, reduced injection pain, and small dosing increments are necessary attributes to improve adherence.
Assisting Patients With GH Device Selection and Use
Allowing patients to choose a delivery device has been associated with better treatment adherence (Kapoor et al., 2008). Ideally, nursing staff familiar with GH devices can assist patients with selection of the GH device best matched to the patient's preferences and needs to maximize treatment tolerability and adherence. Through discussion with the patient and his or her caregivers, nursing staff can learn what device characteristics may make taking daily GH most acceptable and maximize adherence. For example, if the patient fears needles, use of a needle cover or a needle-free device is recommended. Or, if anyone in the patient's household is an intravenous drug user, a needle-free device is recommended. Although selection of the GH device may be determined by the patient's health insurance company formulary guidelines, nursing staff with experience with GH devices can play an essential role in patient education and training in the use of the selected device. Education and training may include device demonstrations, instructional DVDs, product literature, and discussion of the strengths and limitations of the device.
Coaching and support, as well as guidance to parents, provided by nursing staff following device selection are critical to achieve optimal treatment adherence. The patienthealth care provider relationship is key to maximizing adherence (Haverkamp et al., 2008). Possible contributing factors for low adherence that should be addressed with education include the patient's lack of understanding of the disease, optimal treatment, and likely suboptimal outcomes associated with decreased adherence (Rosenfeld & Bakker, 2008; Smith, Hindmarsh, & Brook, 1993). To improve treatment adherence, user-friendly injection pens or needlefree devices (see Table 2) should be selected to prioritize ease of use for self-injection by children. Additionally, it is the experience of the authors that minimal reconstitution and storage requirements, reduced injection pain, and small dosing increments are necessary attributes to improve adherence.