Scottish Growth Hormone Audit Project

Background

In 2003 the National Institute for Clinical Excellence (NICE) produced guidelines for the prescribing of growth hormone (GH) to adult hypopituitary patients; these were subsequently endorsed by the Health Technology Board for Scotland (HTBS). At the time of the issue of the guidelines there was concern within the endocrine community that their interpretation and application might be variable. Accordingly, it was felt that the manner in which growth hormone is prescribed for adult hypopituitary patients needed to be reviewed. The Caledonian Society for Endocrinology agreed to establish an audit project to evaluate how growth hormone is prescribed for adult hypopituitary patients within Scotland, and to assess whether there are distinct regional variations in its availability. This audit, which has been supported by the Society for Endocrinology, should help inform Clinical Endocrinologists on the impact of the NICE Guidelines.

Aim

  1. 1) To define the use of GH replacement for adult hypopituitary patients within Scotland.
  2. 2) To compare use of GH across regions.
  3. 3) To compare rates of GH use in relation to the introduction of NICE/HTBS Guidelines.
  4. 4) To evaluate the way in which NICE/HTBS Guidelines are interpreted in regional centres.
  5. 5) To identify reasons for failure to offer to prescribe GH to appropriate GH deficient hypopituitary patients.
  6. 6) To identify regional variation in prescribing, funding use of shared care schemes with Primary Care in prescribing of GH.

Protocol

All patients prescribed GH in Scotland will be entered on the database. It is estimated that there are approximately 250 patients currently receiving GH throughout Scotland. Patients are mainly seen by the four endocrine centres; Aberdeen, Dundee, Edinburgh and Glasgow. However, all Consultant Endocrinologists across Scotland were invited to participate and completed a questionnaire. All those involved in the prescribing of GH agreed to participate.

The first phase of the project has now been completed and data in relation to adult GH use have been presented to the annual meeting of the Society (BES). A paper that describes the findings is currently being prepared. A final stage of the study is now underway that will examine the reasons for not prescribing GH to adult pateints who are hypopituitary - these results will complement the initial audit, and will be completed by the end of 2008

Ethics

Formal ethical approval for acquisition of these data was not required. This was discussed with the Chair of MREC.

Governance

The Caledonian Society for Endocrinology agreed that the audit would be overseen by a Steering Group, made up of Consultants from the four main Scottish centres plus the Project Manager, which will report to the Clinical Committee of the Society for Endocrinology. The Steering Group is chaired by Professor John Connell.

The Steering Group meets 2-3 times a year and is responsible for setting targets, reviewing output of the research audit and supervising the activity of the Project Manager. It is also responsible for raising any necessary funds and for monitoring and approved expenditure.

Ownership of the data

The data will be owned by the Society for Endocrinology.

Sponsorship

The project is sponsored by an unrestricted two-year grant from Eli Lilly.

Further information

Further information about the project is available from the Project Manager:

Maggie Carson
Endocrine Specialist Nurse
OPD2
The Royal Infirmary
51 Little France Crescent
Edinburgh
EH16 4SA
Tel: +44 (0) 131 242 1378
Email: M.N.Carson@ed.ac.uk