GPs' experiences of phosphatidylethanol in treatment of hypertension: a qualitative study

Background: Hazardous alcohol use increases the risk of hypertension but is underdetected in primary healthcare (PHC) patients. Use of the biomarker phosphatidylethanol (PEth), which reflects the last 2-3 weeks of alcohol consumption, is increasing in Swedish PHC, but studies exploring its use for hypertension are scarce or missing. Aim: To explore GPs' experiences of using PEth to identify hazardous alcohol use in the context of managing hypertension. Design & setting: A qualitative study of GPs (n = 12) experienced in using PEth in hypertension management who were recruited at Swedish primary healthcare centres (PHCC) in 2021. Method: The GPs participated in five focus group interviews. A questioning route was used. The interviews were audio- recorded, transcribed verbatim, and analysed with inductive qualitative content analysis. Results: 'I don't hesitate anymore' was the overall theme, which reflected both the disappearance of GPs' fear that the PEth result might upset the patient, as this rarely occurred, and that the positive effects of PEth predominated in the findings. The theme is underpinned by the following four subthemes: serving as an eye-opener; improving the dialogue; using with care; and learning by doing. Conclusion: PEth is a useful tool that changed GPs' routines for addressing alcohol and identifying hazardous alcohol use in patients with hypertension managed in PHC. The GPs advocated adopting PEth as a routine test in the treatment of hypertension. However, PEth needs to be used with care to maximise benefit and minimise harm.