title: The boom that never was: results of a 10 year audit of paediatric growth hormone prescribing in Scotland.
abstract: OBJECTIVE
  To investigate trends in paediatric growth hormone (GH) prescribing in Scotland.
  
  
  METHODS
  Annual audit of paediatric GH patients, analysed by geographical distribution, diagnosis, age and duration of treatment, dosage, sex ratio and prescribing body.
  
  
  METHODS
  Paediatric patients receiving GH who attended the four tertiary referral centres in Scotland: Glasgow, Edinburgh, Dundee and Aberdeen, from 1990-1999.
  
  
  RESULTS
  The annual total number of paediatric GH recipients ranged from 296-393. The maximum was recorded in 1994, with a progressive decline thereafter. The latest total (296, 1999) represents a 19% decrease since 1990. There is a marked disparity between these figures and projections published by the Scottish Office Clinical Research and Audit Group (CRAG) in 1990 of 500 patients in 1995 and 600 by 2000. CRAG postulated that GH would prove efficacious in a wider range of conditions, that the number of survivors of childhood cancer would increase and that GH therapy would continue following clinical trials. While there has been a relative increase in oncology survivors during the 10-year period, the overall decline in numbers is largely attributable to familial short stature patients in whom there has been a five fold decrease, following completion of clinical trials of GH. The number of children classified "idiopathic growth hormone deficient" has also decreased, as the overlap between this condition and normal variant short stature is increasingly recognised.
  
  
  CONCLUSIONS
  This expensive drug is being used relatively conservatively in Scotland, in the light of research experience. While a small degree of ad hoc usage is inevitable, we strongly support participation in national trials wherever possible. The adoption of an open approach with the Scottish Office regarding GH usage has proved beneficial in alleviating fear of escalating costs and preventing prescribing problems in a country in which 98% of GH is prescribed by general practitioners.
authors.affiliation: Royal Hospital for Sick Children, Glasgow.
authors.forename: W F
authors.initials: WF
authors.lastname: Paterson
authors.forename: M D
authors.initials: MD
authors.lastname: Donaldson
authors.forename: S A
authors.initials: SA
authors.lastname: Greene
authors.forename: C J
authors.initials: CJ
authors.lastname: Kelnar
authors.forename: P J
authors.initials: PJ
authors.lastname: Smail
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D013006:Growth Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008485:Medical Audit; D010372:Pediatrics / Q000592:standards; D010818:Practice Patterns, Physicians'; D012606:Scotland
chemical_list: D013006:Growth Hormone