E-Poster Presentation ESA-SRB-ANZBMS 2021

General practitioner perspectives and experiences when screening for primary aldosteronism in hypertensive patients (#336)

Abhir K Nainani 1 , Jun Yang 2 3 , Grant Russell 1 , Sanne Peters 1
  1. Department of General Practice , Monash University, Melbourne , Victoria , Australia
  2. Department of Medicine , Monash Health , Melbourne , Victoria , Australia
  3. Centre for Endocrinology and Metabolism , Hudson Institute of Medical Research , Melbourne , Victoria , Australia

Background:

Primary aldosteronism (PA) is a common form of hypertension caused by autonomous production of aldosterone independent of renin. Screening with an aldosterone renin ratio enables early detection and targeted treatment, which can reduce cardiovascular complications(1). However, screening rates are low among Australian general practitioners (GPs)(2). Limited awareness is thought to explain the low screening rates in general practice(3). 

Objective:

To understand the factors that influence a GP’s decision to screen for primary aldosteronism.

Method:

We used a qualitative study to explore the experiences of GPs when screening for PA. Set in South-East Melbourne, participating GPs received an educational session on PA from an endocrinologist. We conducted semi-structured interviews with GPs who had screened at least one patient following the teaching session. Interviews were transcribed, independently coded, and analysed for emerging themes.

Results:

The 16 GPs varied by clinical experience (1-35 years), practice location (regional, urban), and number of patients screened for PA (1-44). GPs preferred screening newly diagnosed hypertensive patients. Only a few GPs opted to screen all hypertensive patients, while most questioned the necessity of screening patients whom they thought fitted their clinical impression of essential hypertension. Many GPs found it challenging to both comply with testing requirements and interpret screening results amidst the organisational constraints of their practice. GPs that had diagnosed at least one case of PA acknowledged the significant impact it had on patient wellbeing and this reinforced their role in assisting with the detection of PA. Knowledge, cost, and convenience of the screening process, conceptualisation of risk and perceived impacts of detecting PA influenced the screening experience.

Conclusion:

This study demonstrates that additional factors, other than limited awareness, influence GP screening decisions. Our findings have the potential to inform future policy, practice, and training to improve the detection of PA in Australian general practice.

  1. Catena C, Colussi G, Sechi LA. Treatment of primary aldosteronism and organ protection. Int J Endocrinol 2015: 597247.
  2. Lim YY, Shen J, Fuller PJ, Yang J. Current pattern of primary aldosteronism diagnosis: Delayed and complicated. Aust J Gen Pract. 2018;47(10):712-8.
  3. Mulatero P, Monticone S, Burrello J, Veglio F, Williams TA, Funder JW. Guidelines for primary aldosteronism: uptake by primary care physicians in Europe. J Hypertens. 2016;34(11).