Clinician Perceptions of Barriers and Strategies to Improve Pediatric Hypertension Detection.

Abstract

Pediatric hypertension remains underrecognized despite its high prevalence (approximately 5%) and long-term cardiovascular implications. Although guidelines for screening and diagnosis exist, less than 25% of affected children are diagnosed, and more than half do not receive timely follow-up care. Clinician-specific implementation barriers and directly informed strategies, which may alleviate this gap, are insufficiently described. To identify clinician-reported barriers and actionable recommendations to improve pediatric hypertension detection and follow-up in primary care using the Consolidated Framework for Implementation Research. Semistructured qualitative interviews were conducted between November 1, 2022, and March 31, 2023, with health care clinicians at 10 pediatric primary care clinics. Clinics were purposefully selected based on outpatient follow-up care gaps for patients 1 year or more after initial hypertension diagnosis and the Child Opportunity Index based on clinic address. Transcripts were analyzed thematically and mapped to Consolidated Framework for Implementation Research domains and constructs to identify modifiable barriers and stakeholder-informed recommendations. Clinician-identified barriers and recommended strategies for improving pediatric hypertension detection and follow-up. A total of 25 health care clinicians were interviewed (mean [range] age, 45.1 [28.0-64.0] years; 22 [88%] female). A total of 10 themes emerged; 5 major barriers to hypertension detection were identified that directly aligned with 5 themes for recommendations. Clinicians described (1) lack of standardized clinical pathways, with the recommendation to implement role-specific pathways for blood pressure measurement and follow-up; (2) insufficient training and confidence among clinicians and staff, addressed by competency-based and continuous training programs; (3) electronic medical record systems that did not support blood pressure trend analysis or decision-making, with the recommendation to redesign and optimize integration; (4) variable access to properly maintained and sized equipment, with the recommendation to ensure reliable availability and calibration; and (5) fragmented referral and communication with subspecialists, addressed by establishing structured, shared communication and referral systems. This qualitative study demonstrated that improving pediatric hypertension detection requires targeted strategies that address clinician-level implementation barriers. Stakeholder-informed recommendations offer a roadmap to operationalize clinical guidelines that can improve hypertension detection.