Short stature and growth hormone therapy - A national study of physician recommendation patterns
Short stature and growth hormone therapy - A national study of physician recommendation patterns
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DOI：
10.1001/jama.276.7.531
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发表时间：
1996-08-21
影响因子：
120.7
通讯作者：
Neuhauser, D
中科院分区：
文献类型：
--
作者：
Cuttler, L;Silvers, JB;Neuhauser, D
客观。-为了确定目前的专家意见和建议，关于使用生长激素（GH）来治疗没有经典GH缺乏症（非GHD儿童）的矮小儿童的争议问题。研究设计。对一项全国性调查的分析，该调查邮寄给了534名美国医生专家，他们对身材矮小的管理（儿科内分泌学家）的应答率为81.3%。专家的生长激素治疗说明.结果. -医生报告说，目前接受GH治疗的患者中约有58%患有经典GH缺乏症，而42%患有其他疾病。在所有病例情景中，推荐GH治疗矮小非GHD儿童的医生比例范围为1%至74%。GH被推荐的可能性取决于儿童的生理生长特征，儿童的身高，生长速度和预测的成年身高），偶然因素（强烈的家庭愿望或GH成本的减少），以及医生的信念（身材矮小对幸福的影响，GH治疗的有效性），这些因素中的每一个都发挥了高度显著的，独立的，和累加效应的决定，建议GH.结论. -我们的研究结果表明，许多儿科内分泌学家认为生长激素治疗适合于选定的短期非GHD儿童，超出了目前食品和药物管理局批准的生长激素适应症。决定建议生长激素的非GHD儿童休息的组合，医疗，社会和感知因素;治疗模式的变化源于这些影响的变化。未来生长激素的使用可能不仅取决于对照试验的结果，还取决于家庭偏好、生产商定价以及医生对身高和生长激素治疗价值的看法。
Objective.-To determine current expert opinion and recommendations regarding the controversial issue of the use of growth hormone (GH) to treat short children who do not have classical GH deficiency (non-GHD children).Study Design.-Analysis of a national survey mailed to 534 US physician experts on the management of short stature (pediatric endocrinologists) with a response rate of 81.3%.Main Outcome Measure.-The experts' GH treatment recommendations.Results.-The physicians reported that approximately 58% of their current patients undergoing GH therapy have classical GH deficiency, while 42% have other conditions. The proportion of physicians who recommended GH treatment of short non-GHD children ranged from 1% to 74% over all case scenarios presented. The likelihood of GH being recommended depended on the physiological growth characteristics of the child tie, the child's height, growth rate, and predicted adult height), contingency factors tie, strong family wishes or a reduction in GH cost), and physician beliefs tie, the impact of short stature on well-being, the effectiveness of GH therapy), Each of these factors exerted highly significant, independent, and additive effects on decisions to recommend GH.Conclusion.-Our results indicate that many pediatric endocrinologists consider GH treatment appropriate for selected short non-GHD children, going beyond current Food and Drug Administration-approved indications for GH. Decisions to recommend GH for a non-GHD child rest on a combination of medical, social, and perceptual factors; variations in treatment patterns stem from variations in these influences. Future GH use will likely be determined not only by the results of controlled trials, but also by family preferences, producer pricing, and physician perceptions of the value of height and GH therapy.