Perception of Adherence to Daily Human Growth Hormone Treatments Among Pediatric and Adolescent Patients in Japan: A Cross-Sectional Survey of Physicians and Caregivers

Figures & data

Table 1 The 8-Item Morisky Medication Adherence Scale Items

Do you sometimes forget to administer your medication?

2. People sometimes miss taking their medication for reasons other than forgetting. Thinking over the past 2 weeks, were there any days when you missed taking the medication?

3. Have you ever cut back or stopped administering the medication without telling the doctor because the patient felt worse when they took it?

4. When you travel or leave home, do you sometimes forget to bring along the medication?

5. Did you administer medication yesterday?

6. When you feel like the condition is under control, do you sometimes stop administering medication?

7. Administering medication every day is a real inconvenience for some people. Do you ever feel hassled about sticking to the treatment plan?

8. How often do you have difficulty remembering to administer all the medication?

Table 2 Physician Baseline Characteristics

	n (%)
Total	123 (100.0)
Gender
Male	99 (80.5)
Female	24 (19.5)
Age (years)
20–29	9 (7.3)
30–39	40 (32.5)
40–49	29 (23.6)
50–59	28 (22.8)
≥60	17 (13.8)
Primary specialty
Pediatrics	75 (61.0)
Diabetes/endocrinology	48 (39.0)
Certifications
Pediatrics	65 (52.8)
Endocrinology	31 (25.2)
Type of facility
National/municipal/public	73 (59.3)
Private/individually owned	50 (40.6)
Number of beds
<100	16 (13.0)
100–199	11 (8.9)
≥200	96 (78.0)
Pediatric GHD patients by school age (n=757)
Pre-elementary school	120 (15.9)
1st year to 3rd year elementary school	211 (27.9)
4th year to 6th year elementary school	239 (31.6)
Middle school	187 (24.7)

Table 3 Caregiver (and Patient) Baseline Characteristics

	n (%)
Total	112 (100.0)
Caregiver gender
Male	51 (45.5)
Female	61 (54.5)
Caregiver age (years)
20–29	3 (2.7)
30–39	49 (43.8)
40–49	47 (42.0)
≥50	13 (11.6)
Primary facility type
Hospital	71 (63.4)
Clinic	41 (36.6)
Primary department treated by
Pediatrics	90 (80.4)
Diabetes/metabolic/endocrinology	14 (12.5)
Internal medicine	5 (4.5)
Other	1 (0.9)
Do not know	2 (1.8)
Patient gender
Male	74 (66.1)
Female	38 (33.9)
School age
Pre-elementary school	33 (29.5)
1st year to 3rd year elementary school	36 (32.1)
4th year to 6th year elementary school	27 (24.1)
Middle school	16 (14.3)

Figure 1 Perceived and reported adherence based on the MMAS-8 instrument. *Physicians were asked to report adherence for all patients based on MMAS-8. Physicians treated 757 patients overall. **Caregivers were asked to report adherence for themselves based on MMAS-8.

Figure 2 Perceived and reported adherence based on the MMAS-8 instrument by school-age of child. *Physicians were asked to report adherence for all patients based on MMAS-8. Physicians treated 757 patients overall. **Caregivers were asked to report adherence for themselves based on MMAS-8.

Table 4 Experience Having Missed an Injection Once or More During a 1-Week Period by Adherence Based on MMAS-8 Instrument

n (%)	All Caregivers (n=112)	Poor Adherence Caregivers^a (n=36)	Moderate/Good Adherence Caregivers (n=76)
Yes	65 (58.0)	30 (83.3)	35 (46.1)
No	47 (42.0)	6 (16.7)	41 (53.9)

Notes: ^aChi-square test of “Poor adherence caregivers” and “Moderate/good adherence caregivers” yielded a p-value of <0.001. A p-value <0.05 was considered significant based on a Chi-squared test.

Table 5 Reason for Not Being Able to Inject GH Treatment; Poor Adherence Caregivers and Moderate/Good Adherence Caregivers (Base: Those Who Have Experienced Missing an Injection Once or More Often During a 1-Week Period)

n (%)	All Caregivers (n=65)	Poor Adherence Caregivers (n=30)	Moderate/Good Adherence Caregivers (n=35)	p-value
Simply forgot	34 (52.3)	21 (70.0)	13 (37.1)	0.008
Went somewhere and stayed overnight	20 (30.8)	6 (20.0)	14 (40.0)	0.082
Patient refused/resisted	12 (18.5)	8 (26.7)	4 (11.4)	0.114
Worried about side effects	10 (15.4)	10 (33.3)	0 (0.0)	<0.001
Busy with school activities, etc	9 (13.8)	5 (16.7)	4 (11.4)	0.542
Worried about safety	7 (10.8)	7 (23.3)	0 (0.0)	0.002
Injection pain	6 (9.2)	5 (16.7)	1 (2.9)	0.055
Emotional or physical burden of long-term treatment on patient	5 (7.7)	4 (13.3)	1 (2.9)	0.114
Ran out of medication/was unable to resupply/forgot to resupply	4 (6.2)	4 (13.3)	0 (0.0)	0.026
Dissatisfied with treatment efficacy	4 (6.2)	3 (10.0)	1 (2.9)	0.232
Emotional or physical burden of long-term treatment on caregiver	3 (4.6)	3 (10.0)	0 (0.0)	0.055
Treatment cost burden	1 (1.5)	0 (0.0)	1 (2.9)	0.351
Other	11 (16.9)	5 (16.7)	6 (17.1)	0.959

Notes: Data are expressed as number (percentage). A p-value <0.05 was considered significant based on a Chi-squared test.

Figure 3 Potential impact of a once-weekly option on adherence to GH treatment according to physicians and caregivers. *Physician perception assuming 10 patients with poor adherence (123 physicians × 10 patients each = 1230 patients). **Asked to caregivers that have experienced missing an injection once or more during a 1-week period (n=65).