Best-Practice Alert to promote screening for primary aldosteronism among people with apparent treatment resistant hypertension

Abstract

Guidelines recommend that all people with resistant hypertension (RH) should be screened for primary aldosteronism (PA). However, less than 2% of people with RH are screened for PA. We aimed to develop a non-interruptive Best Practice Alert (BPA) and assess if implementation of the BPA in the Electronic Health Record (EHR) improved the screening rate for PA among people with apparent treatment resistant hypertension (aTRH). We implemented a non-interruptive BPA on 9/17/2022 at our ambulatory Primary care, Endocrinology, Nephrology, and Cardiology clinics. We assessed clinical parameters of people with aTRH before (9/17/2021-9/16/2022) and after (9/17/2022-9/16/2023) the BPA was implemented. The non-interruptive BPA embedded with an order set identified people with aTRH and recommended screening for PA if it was not previously performed. There were 10,944 and 11,463 people with aTRH who attended office visits during the 12 months before and after the BPA implementation, respectively. There were no statistically significant differences in median age (p=0.096), sex (p=0.577), race (p=0.753), and ethnicity (p=0.472) between the pre- and post- BPA implementation groups. There was a significant increase in PA screening orders placed (227 (2.1%) vs 476 (4.2%), p<0.001), and PA screening labs performed (169 (1.5%) vs 382 (3.3%), p<0.001) after BPA implementation. PA screening tests were positive in 26% (44/169) and 23% (88/382) of people in the pre- and post- BPA groups, respectively (p=0.447). In summary, implementation of a real-time EHR BPA doubled the screening rate for PA among people with aTRH however the overall screening rate was low.