Using electronic clinical decision support in primary care to enhance identification of primary aldosteronism: a protocol for the CONSEP cluster-randomised controlled trial

Primary aldosteronism (PA) is a common and treatable cause of hypertension, affecting up to 15% of patients in primary care, yet it remains substantially underdiagnosed. Recent international guidelines recommend routine screening for PA in all individuals with hypertension, highlighting the need for effective implementation strategies in general practice. We aim to determine whether an electronic clinical decision support (eCDS) tool integrated into general practice software improves PA screening and diagnosis. CONSEP (CONn Syndrome screening and Evaluation in Primary care) is a pragmatic cluster randomised controlled trial conducted in general practices across three Australian states. Practices will be block-randomised by size and location (state) in a 1:1 ratio to intervention (eCDS) or control. Patients eligible for analysis will be adults with hypertension attending participating practices. De-identified data will be extracted from clinical software at baseline, 12 months, and 24 months. Analyses will follow intention-to-treat principles using regression models accounting for clustering at the practice level. Primary outcomes are the proportion of patients screened for PA within 12 months and the proportion diagnosed with PA within 24 months. Secondary outcomes include blood pressure control, antihypertensive medication burden, cost-effectiveness, and a process evaluation assessing acceptability, feasibility, and sustainability. By embedding guideline-based screening into routine workflows, this trial addresses a major evidence-practice gap in hypertension care. If effective, the intervention could improve hypertension management, increase detection of PA, and reduce long-term cardiovascular risk in primary care.