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SP8 Pharmacist-led centralised prescribing service for paediatric growth hormone in South Wales
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  1. Ross Burrows
  1. Cardiff and Vale University Health Board

Abstract

Aim To standardise the supply and monitoring of growth hormone to children across the tertiary paediatric endocrine service and ensure cost-effective prescribing of growth hormone in children.

Method Patients identified by recorded data on the Growth Analyser® database used by the paediatric endocrine team. A pharmacist reviewed the current process and using process mapping identified ways of simplifying the registration process for new starters in different health boards. Patients and families offered to register with new service during the annual tertiary endocrine review clinic, or more urgently if issues identified and raised by the patients/family to the pharmacist. The pharmacist completed registration paperwork and prescribed growth hormone 6 monthly, ensuring appropriate monitoring is conducted before prescribing. All patients transitioned to new service recorded on Excel spreadsheet comparing monthly cost on the previous service, to monthly cost on the current service.

Results 150 patients identified on growth hormone across 6 health boards prescribed majority via GP with few via homecare at an approximate cost of £800,000 a year. Over 1 year now 90 patients prescribed by the pharmacist based in the paediatric endocrine team and supplied by homecare. Resulting in cost savings of £100,000 a year, an average of £1,700 per patient, with the most significant cost saving of £4,400 a year for one patient. The time taken to start a new patient on growth hormone has reduced from an average of 6 weeks to 2 weeks, due to less burden on GP and shared care agreements. Reduced burden on specialist nurses to complete paperwork, deal with queries and chase prescriptions as managed by the pharmacist. Support to consultants to ensure patients are monitored at least every 6 months as per BSPED recommendations1 and NICE guidance.2

Conclusion Pharmacist-led prescribing of growth hormone can reduce the burden on consultants, specialist nurses, and GP’s, and standardise the supply and support that patients and their families receive when starting growth hormone. Ensuring patients receive treatment in a timely manner and receive appropriate monitoring regardless of where they live. Supplying growth hormone via homecare is more cost-effective than supplying via primary care. Utilising a pharmacist to oversee this service, identify and approach patients and their families to transition over to the new service can achieve significant cost savings to the NHS, without adding pressure to the specialist team.

References

  1. British Society for Paediatric Endocrinology and Diabetes (2017). Clinical Standards for GH Treatment in Childhood & Adolescence. Available at: https://www.bsped.org.uk/media/1372/gh-standards-document_nov2017.pdf

  2. National Institute for Health and Care Excellence. (2010). Human growth hormone (somatropin) for the treatment of growth failure in children [NICE TA188].Available at: www.nice.org.uk/guidance/TA188

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