‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism
Objective We sought to understand the factors that influence a general practitioner’s (GP’s) experience of screening for primary aldosteronism (PA) in hypertensive patients.Design A qualitative study, framed by phenomenology, using semistructured interviews that were audiorecorded, transcribed verba...
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| Language: | English |
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e061671.full |
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| author | Sanne Peters Jun Yang Grant Russell Abhir Krishan Nainani |
| author_facet | Sanne Peters Jun Yang Grant Russell Abhir Krishan Nainani |
| author_sort | Sanne Peters |
| collection | DOAJ |
| description | Objective We sought to understand the factors that influence a general practitioner’s (GP’s) experience of screening for primary aldosteronism (PA) in hypertensive patients.Design A qualitative study, framed by phenomenology, using semistructured interviews that were audiorecorded, transcribed verbatim, entered into NVivo V.12.0 for coding and analysed for emerging themes.Setting Melbourne, Australia.Participants Eligible GPs had received education on PA as part of a previous study. We recruited a purposive sample of 16 GPs (6 females, 10 males) who varied in practice location, clinical experience and the number of patients screened for PA.Results Although GPs had been educated about PA, they found it challenging to explain the condition to patients and were uncertain about how to screen patients who were already taking antihypertensive medications. Most viewed the screening process to be practical, inexpensive and, by and large, acceptable to their patients. However, they found it inconvenient to alter antihypertensive medications before screening to allow for easier interpretation of the aldosterone-renin ratio. They were also less enthused about screening patients whom they thought fitted a clinical picture of essential hypertension. Knowledge of the screening process, cost and convenience of performing the aldosterone–renin ratio, conceptualisation of risk related to PA, and a desire to improve clinical care were influencing factors that modified the GPs’ screening experience.Conclusion Our findings suggest that knowledge gaps, practical limitations of the aldosterone–renin ratio, and errors in diagnostic reasoning were challenges of routine PA screening. Most of these practical barriers could be addressed by relatively simple educational and practice modifications to increase PA screening rates and optimise detection for the most common cause of secondary hypertension in primary care. |
| format | Article |
| id | doaj-art-e0ef106cd4ea441f90eae34df28f64a0 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e0ef106cd4ea441f90eae34df28f64a02025-01-28T06:20:09ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-061671‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronismSanne Peters0Jun Yang1Grant Russell2Abhir Krishan Nainani3School of Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China8 Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, AustraliaDepartment of General Practice, Monash University, Clayton, Victoria, AustraliaObjective We sought to understand the factors that influence a general practitioner’s (GP’s) experience of screening for primary aldosteronism (PA) in hypertensive patients.Design A qualitative study, framed by phenomenology, using semistructured interviews that were audiorecorded, transcribed verbatim, entered into NVivo V.12.0 for coding and analysed for emerging themes.Setting Melbourne, Australia.Participants Eligible GPs had received education on PA as part of a previous study. We recruited a purposive sample of 16 GPs (6 females, 10 males) who varied in practice location, clinical experience and the number of patients screened for PA.Results Although GPs had been educated about PA, they found it challenging to explain the condition to patients and were uncertain about how to screen patients who were already taking antihypertensive medications. Most viewed the screening process to be practical, inexpensive and, by and large, acceptable to their patients. However, they found it inconvenient to alter antihypertensive medications before screening to allow for easier interpretation of the aldosterone-renin ratio. They were also less enthused about screening patients whom they thought fitted a clinical picture of essential hypertension. Knowledge of the screening process, cost and convenience of performing the aldosterone–renin ratio, conceptualisation of risk related to PA, and a desire to improve clinical care were influencing factors that modified the GPs’ screening experience.Conclusion Our findings suggest that knowledge gaps, practical limitations of the aldosterone–renin ratio, and errors in diagnostic reasoning were challenges of routine PA screening. Most of these practical barriers could be addressed by relatively simple educational and practice modifications to increase PA screening rates and optimise detection for the most common cause of secondary hypertension in primary care.https://bmjopen.bmj.com/content/12/6/e061671.full |
| spellingShingle | Sanne Peters Jun Yang Grant Russell Abhir Krishan Nainani ‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism BMJ Open |
| title | ‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism |
| title_full | ‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism |
| title_fullStr | ‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism |
| title_full_unstemmed | ‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism |
| title_short | ‘I can’t understand why others don’t screen more’: a qualitative study exploring why Australian general practitioners screen for primary aldosteronism |
| title_sort | i can t understand why others don t screen more a qualitative study exploring why australian general practitioners screen for primary aldosteronism |
| url | https://bmjopen.bmj.com/content/12/6/e061671.full |
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