Diagnostic Hesitancy of Primary Care Physicians in Puerto Rico Toward Alzheimer's Disease and Related Dementias: Opportunities for Transformation

Objective: Migration of physicians in Puerto Rico makes it difficult to obtain specialized care for Alzheimer's disease and related dementias (ADRD). Primary care physicians (PCPs) can fill this gap, but there is limited information on how their beliefs and behaviors towards ADRD affect early diagnostic practices. Using the Theory of Planned Behavior (TPB), we addressed salient beliefs of PCPs that affect their intention to diagnose ADRD early, defined as "performing the recommended clinical testing to diagnose ADRD within 3 months from the patient's first subjective memory complaint".Methods: This cross-sectional study included 103 Puerto Rican PCPs, surveyed at CME activities and online. We measured PCPs salient beliefs in terms of attitudes, pressure they feel from others, self-perception of ability to diagnose ADRD early, and intention to perform early diagnosis. Questionnaire measures were psychometrically acceptable.Results: Structural equation modeling (PLS-SEM) analysis showed that, combined, framework constructs explained 35.7% of the variance, reflecting a moderate-to -strong intention of PCPs to diagnose early (R-2 = 0.357, p < 0.001). Self-perception of skills was the strongest predictor of intention (ss= 0.378, p < 0.001). Hours in ADRD training and years of experience in medical practice were strongly correlated with the percentage of total diagnoses performed by PCPs.Conclusion: Training and years of experience may be key for PCPs to have a positive outlook of their skills for early ADRD diagnosis. Findings could be useful to design interventions to dispel myths about ADRD, reduce stigma, and reduce diagnostic hesitancy toward ADRD among PCPs.