Improving Equitable Access to Neurology Care to Achieve Pharmacoequity for Older Adults with ADRD - PROJECT SUMMARY Alzheimer’s Disease and Delated Dementias (AD/ADRD) affect 6.9 million adults in the US and afflicts Hispanic and Black Americans at 1.5 to 2 times the rate of White Americans, respectively. Despite the higher risk of ADRD among Hispanic and Black older adults, they experience significant disparities in quality of ADRD care, including diagnostic delays, lower receipt of neurologic specialty care, and poorer access to medications to manage the disease. Novel medications for AD, such as newly approved anti-amyloid monoclonal antibody (mAb) therapies, represent a significant turning point for the treatment of AD/ADRD as the first-ever disease modifying therapies for this condition. While the effectiveness of the first mAb therapies are modest, and carry important adverse effects, they are posited to be the first in a line of several forthcoming therapies intervening on the basic biological processes of AD/ADRD. Critically, only patients with early mild cognitive impairment or in the early stages of AD are eligible for current mAb therapies, highlighting the importance of early detection and specialist referrals. Given previously observed disparities in access to neurology care and the importance of early referral to ensure timely initiation of ADRD therapies, understanding and eliminating barriers to successful neurology referrals and improving patient, care partner, and primary care provider (PCP) knowledge of ADRD has the potential to reduce racial and ethnic disparities in access to current and future novel ADRD therapies. The overall objective of our proposal is to prepare for a community-engaged clinical trial of a patient navigation intervention to improve equitable access to neurology and ultimately novel ADRD therapies for Black and Hispanic older adults. Guided by the National Institute of Neurological Disorders and Stroke (NINDS) Social Determinants of Health Framework and a Pharmacoequity Framework, our interdisciplinary research team will examine the fundamental factors that inform specialist referral and shape prescribing disparities in ADRD including structural, social, intermediate, intrapersonal, and biological determinants of health factors. The specific aims are to: (1) Quantify the magnitude of effect and relative contribution of patient, provider, health system, and structural factors associated with racial and ethnic disparities in neurology visits and initiation of ADRD therapies at six regional hospitals in California; (2) Identify barriers to and facilitators of successful neurology referrals for ADRD from primary care through qualitative interviews with patients, care partners, and PCPs; (3) Partner with a Community Advisory Board and Stakeholder Advisory Group to develop, refine, and assess the feasibility and acceptability of a patient navigation intervention to optimize neurology access for Black and Hispanic 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 equitable access to current and future ADRD therapies.
