Clinical decision-making in primary aldosteronism screening, diagnosis and management: A qualitative study

<p dir="ltr">Primary Aldosteronism (PA) is an endocrine cause of hypertension. Although it accounts for up to 14% of cases of hypertension, in Australia, PA screening rates are below 1%. Underdiagnosis and diagnostic delay contributes to cardiovascular complications for individuals living with PA. The factors underlying PA underdiagnosis and undertreatment are not well understood, and were explored in this study.</p><p dir="ltr">A qualitative exploratory approach was used to understand the key factors that determine clinical decision-making in the screening, diagnosis and treatment of PA. Semi-structured interviews were conducted with 8 cardiologists, 10 endocrinologists, 10 general practitioners and 10 nephrologists across Australia. Interview transcripts were analysed using inductive reflexive thematic analysis.</p><p dir="ltr">Four explanatory themes were developed that encompassed factors affecting clinician decision-making: 1) clinician experience, knowledge and perceptions; 2) complexity and burden of PA screening and diagnosis; 3) accessibility to services and information; and 4) health system, government and organisational factors. The findings revealed here highlight several areas for development of clinician-targeted interventions to improve PA detection and management. </p>