Barriers and enablers to primary aldosteronism detection in rural, regional, and remote populations — ASN Events
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  3. Barriers and enablers to primary aldosteronism detection in rural, regional, and remote populations

Barriers and enablers to primary aldosteronism detection in rural, regional, and remote populations (#360)

Sarah Lum 1 2 , Sandra Hakim 3 4 5 , Lin H Aye 1 , Lucien Marcel 1 , Peter J Fuller 1 2 , Jun Yang 1 2 6 , Katrina Long 4 5 7
  1. Centre for Endocrinology and Reproductive Health, Hudson Institute of Medical Research, Melbourne, VIC, Australia
  2. Department of Molecular and Translational Science, Monash University, Melbourne, VIC, Australia
  3. School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
  4. National Centre for Healthy Ageing, Frankston Hospital, Melbourne , VIC, Australia
  5. Peninsula Health, Frankston Hospital, Melbourne, VIC, Australia
  6. Department of Medicine, Monash University, Melbourne, VIC, Australia
  7. Department of Occupational Therapy, School of Primary and Allied Health Care , Monash University, Melbourne, VIC, Australia

Background

Primary aldosteronism (PA) is the most common cause of secondary hypertension, affecting 5-10% of individuals with hypertension and up to 30% of those with resistant hypertension. Despite its excess cardiovascular, renal, and metabolic risk beyond blood pressure-matched essential hypertension, PA remains markedly underdiagnosed. Rural, regional, and remote (RRR) communities experience a disproportionate cardiovascular disease burden, yet barriers to equitable PA care are poorly understood.

Aims

To synthesise evidence on barriers and enablers to PA screening, diagnosis, and management in RRR populations using an implementation science framework.

To identify implementation strategies used in reported interventions and map to implementation strategy taxonomy.

Methods

We searched PubMed, MEDLINE, Embase, CINAHL, CENTRAL, and Scopus (1 January 2000 - 31 March 2026). Reported barriers and enablers were coded to the five domains of the updated Consolidated Framework for Implementation Research (CFIR): Innovation, Outer Setting, Inner Setting, Individuals, and the Implementation Process domains. Strategies proposed to improve PA care were classified using the Expert Recommendations for Implementing Change (ERIC).

Results

Of 1,142 records, eight studies met inclusion criteria; none specifically targeted RRR populations. Barriers were concentrated in Individuals (clinician knowledge and decision-making, patient complexity), Inner Setting (limited specialist and laboratory access, professional isolation), and Innovation (multi-step pathway, test interpretation, medication switching). Proposed strategies aligned with six ERIC implementation clusters: stakeholder education, clinician support, contextual adaptation, infrastructure enhancement, stakeholder partnerships, and consumer engagement.

Conclusion

PA detection in RRR settings is under-researched with substantial health equity implications. Barriers reflect a complex, multilevel interplay across patient, clinician, health-system, and innovation domains, with Inner Setting constructs carry particular weight for RRR populations. Although the 2025 Endocrine Society guideline recommends broad PA screening, implementation in RRR settings will require real-world testing of currently unevaluated implementation strategies.