Abstract P435: Barriers For Secondary Hypertension Screening In The Us: A National Physician Survey

Abstract

Background: Although US and international expert guidelines recommend screening for secondary hypertension in patients with treatment-resistant hypertension (RHTN) and other high-risk groups, screening is conducted in <3% of candidates. Objective: To determine barriers for secondary hypertension screening across US practices. Participants and Measurements: Internists, family practitioners, cardiologists, nephrologists, and endocrinologists, randomly selected from active members of the American Medical Association were surveyed on barriers for secondary hypertension screening. Results: Response rate was 67% (425 of 633 response-eligible physicians). The leading reported barriers preventing secondary hypertension screening included visit time constraints (43.5%), poor ancillary support (29.4%), and testing-related logistics (27.5%). Physicians practicing in large medical groups or staff-model HMO were more likely than physicians in private practice to not have access to specialists (adjusted OR, 95% CI: 4.01 [1.19-13.47]), and to be unfamiliar with screening results interpretation and next steps (2.11 [1.03-4.32]), but less likely to report poor ancillary support (0.47 [0.28-0.79]) or reimbursement concerns (0.29 [0.13-0.63]). Primary care physicians were more likely than endocrinologists (16.67 [2.04-100.00]) and nephrologists (10.00 [1.32-100.00] to lack familiarity with testing interpretation and subsequent steps. Physicians in practices covered primarily by Medicare were more likely to report poor ancillary support (2.02 [1.16-3.53]), and lack of access to specialists (4.96 [1.04-23.52]) as compared to physicians in practices covered primarily by private health insurance. Conclusions: Our findings suggest an urgent need to address major barriers to secondary hypertension screening, including ensuring adequate clinic visit time, ancillary support, and timely access to specialists.