Patients’ experiences of phosphatidylethanol in hypertension treatment in primary care: qualitative study

Background Alcohol is not routinely addressed in the management of hypertension. The use of the alcohol biomarker Phosphatidylethanol (PEth) is increasing in primary care but patients’ experiences of PEth in primary care are unexplored.

Aim To investigate the experiences of patients regarding PEth in the treatment of hypertension in primary care, regardless of their alcohol consumption levels.

Design & setting Qualitative interview study with 13 patients, mean age 67 years, with hypertension (ICD-10 code I10.9), in Swedish primary care, 2023-2025.

Method Semi-structured individual interviews were conducted, audio-recorded, transcribed and analysed with Grounded Theory.

Results The final theory Double-layered insight consists of two categories: Personal concern and agency and Trusting the healthcare system to deliver. Each category illustrates barriers to and facilitators of motivation to change alcohol-related behaviours. The two additional categories Losing trust and Empowered by insight describes the emotional responses emerging in relation to the identified barriers and facilitators. Patients viewed physicians as having the mandate to address alcohol use, despite its sensitivity. They valued PEth for its objectivity and emphasised the importance of transparency and non-judgemental, person-centred dialogue. Although PEth could evoke discomfort, it was generally seen as meaningful, despite some ambivalence about whether testing should be optional.

Conclusion The results indicate that the judicious use of PEth is perceived of importance to prevent adverse outcomes and promote positive change. The results also indicate that actions of both the patient and the general practitioner may have an impact on the patient’s alcohol use aligning with person-centred care.