Barriers to workup and referral of primary hyperparathyroidism: A qualitative study of providers' perspectives.

Background: Patients with primary hyperparathyroidism are underdiagnosed and undertreated. As the treatment pathway starts in primary care, we sought to examine the barriers primary care providers encounter when diagnosing and referring patients with primary hyperparathyroidism.

Methods: We conducted semistructured interviews with 19 primary care providers. Virtual interviews were audio-recorded, transcribed verbatim, and deidentified. A multidisciplinary team coded and analyzed all transcripts using deductive thematic analysis based on the Disparities in the Treatment of primary hyperparathyroidism framework.

Results: Providers overall felt comfortable diagnosing straightforward primary hyperparathyroidism, but struggled with nuanced or complex cases, and desired ways to informally discuss cases with specialists. Commonly identified barriers to workup include competing patient social and medical priorities and lack of time and patient education resources to guide patients through the needed steps. Primary care providers identified areas for improvement including developing resources to help busy primary care providers educate patients on primary hyperparathyroidism, locally tailored diagnostic and referral algorithms, and the ability to obtain informal input from surgeons.

Conclusions: Primary care providers are generally knowledgeable of primary hyperparathyroidism and its management; however, they often face barriers in understanding the nuances of primary hyperparathyroidism and coordinating a multistep workup in a time-limited setting. This presents opportunities for action, including creating patient-centered education materials on primary hyperparathyroidism for providers to use, and specialists making their expertise more available to local primary care providers via e-consults and clear referral pathways and guidelines. Ultimately, eliminating barriers to workup and referral will improve the care of patients with primary hyperparathyroidism.