title: Barriers to diagnosing and managing hypertension - a qualitative study in Australian general practice.
abstract: BACKGROUND
  Elevated blood pressure (BP) is a major modifiable risk factor. However hypertension still remains underdiagnosed, untreated or suboptimally treated. This study aimed to identify and explore barriers to initiating medication and treating elevated BP to target levels in the general practice setting.
  
  
  METHODS
  Six focus groups involving 30 clinicians were audio recorded, transcribed in full and analysed for common emerging themes using an iterative thematic analysis.
  
  
  RESULTS
  After making the decision to commence treatment, medication initiation was relatively straightforward. Clinical uncertainty about true underlying BP, distrust of measurement technology, and distrust of the evidence underpinning hypertension management were expressed. Patient age, gender and comorbidity influenced treatment strategy. Related themes included perceived patient attitude, clinical inertia, and patient centred care. Systems issues included lack of resources and lack of time.
  
  
  CONCLUSIONS
  The management of an asymptomatic chronic disease within a patient centred, encounter based primary care context can be challenging.
authors.affiliation: Discipline of General Practice, Menzies Research Institute, Hobart, Tasmania.
authors.forename: Faline
authors.initials: F
authors.lastname: Howes
authors.forename: Emily
authors.initials: E
authors.lastname: Hansen
authors.forename: Danielle
authors.initials: D
authors.lastname: Williams
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001315:Australia; D017144:Focus Groups; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D036301:Qualitative Research; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents