Improving Access to Neurology Care to Achieve Pharmacoequity for Older Adults with ADRD

Alzheimer's Disease and related dementias (AD/ADRD) are increasingly common, costly, and morbid, affecting nearly 7 million older adults in the U.S. Prior research has shown significant variation in neurology care access among older adults with ADRD, with some populations substantially less likely to complete neurology specialist visits and ultimately less likely to initiate existing therapies to manage ADRD; yet few studies have examined the drivers of this variation in access to neurology care or developed patient-centered interventions to eliminate such variation in access to care and outcomes of care. The goal of this study is to understand the multilevel obstacles to and facilitators of access to neurology care and develop an evidence-based patient navigation intervention to optimize neurology access from primary care for populations experiencing gaps in care, while improving access to future novel ADRD therapies. 

Our interdisciplinary research team, including a Stakeholder Advisory Group including leadership across the University of California and national experts as well as a Community Advisory Board with members from leadership across community orgnizations in Southern California, is examining the fundamental factors that inform specialist referral and shape prescribing variation in ADRD including intermediate and intrapersonal health factors. The specific aims are to: 

1. Quantify the magnitude of effect and relative contribution of patient, provider, health system, and system factors associated with variation in neurology visits and initiation of ADRD therapies at six regional hospitals in California; 
2. Identify impediments to and facilitators of successful neurology referrals for ADRD from primary care through qualitative interviews with patients, care partners, and PCPs; 
3. Develop, refine, and assess the feasibility and acceptability of a patient navigation intervention to optimize neurology access for older adults with ADRD. Completion of these aims will allow us to design and implement a multi-site clinical trial aimed at improving neurology specialist referrals to advance access to current and future ADRD therapies.