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

## TL;DR

This study explores why hypertension in children is often missed in primary care and suggests strategies to improve detection and follow-up.

## Contribution

The study identifies clinician-recognized barriers to pediatric hypertension detection and proposes targeted, system-level solutions based on stakeholder input.

## Key findings

- Five major barriers to hypertension detection were identified, including lack of standardized pathways and inadequate training.
- Clinicians recommended role-specific pathways, optimized electronic medical records, and structured communication with specialists.
- Stakeholder-informed strategies offer a roadmap to improve hypertension detection and guideline implementation.

## Abstract

What are barriers to detection of hypertension among children in primary care settings, and what strategies do clinicians recommend to address these barriers?

In this qualitative study of 25 clinicians across 10 pediatric primary care clinics, barriers included lack of standardized clinical pathways, inadequate training, inefficient electronic medical records, inconsistent equipment access, and poor coordination with specialists. Clinicians recommended standardized role-specific pathways, competency-based training, optimized electronic medical record tools, reliable equipment systems, and structured communication with subspecialists.

This study’s results suggest that addressing clinician-identified barriers through targeted, system-level strategies may improve pediatric hypertension detection and management.

This qualitative study of clinicians in pediatric primary care clinics explores clinician-identified barriers to hypertension detection and addresses these barriers in alignment with the Consolidated Framework for Implementation Research.

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.