Clinician's attitudes & perspective on chemical adherence testing in hypertension (CATCH): A qualitative interview...

Chemical Adherence Testing (CAT) is gaining prominence as a reliable and valid clinical method to detect whether antihypertensive agents are being taken as prescribed. This study aimed to explore clinicians' attitudes and perspectives on the clinical use of CAT.

Clinicians involved in hypertension care were recruited through purposive and snowball sampling (N = 9). Participants represented general practice, cardiology, geriatric medicine, clinical pharmacology, nephrology and internal medicine. Semi-structured interviews were carried out, and transcripts were analysed using reflexive thematic analysis with an inductive, constructivist approach. Theme development was peer-reviewed by a health psychologist and clinical pharmacologist to enhance reflexivity.

Three themes were developed: (1) The impactful weight of new evidence- CAT was perceived as a valuable, more objective tool for checking for non-adherence and informing treatment, especially in cases of suspected treatment-resistant hypertension; (2) CAT meets clinical reality- participants highlighted practical barriers such as test availability, workflow disruption, staffing needs and costs that could impact implementation in an overburdened healthcare system; (3) The human side of CAT- while CAT supported discussions around adherence, clinicians highlighted the need for trust, consent and sensitive communication to avoid perceptions of policing or blame.

Clinicians viewed CAT as a promising tool for improving diagnostic clarity and prompting adherence discussions. However, concerns about logistical feasibility, ethical use and potential strain on patient relationships were evident. Successful implementation requires clinician training, clear communication and system-level support to ensure CAT is integrated in an ethical, patient-centred way that preserves trust and supports collaborative care.