TABLE 3.

Factors considered in referral decision‐making process: Physician/payer survey insights.

Factors increasing likelihood of referral (decreasing order of importance)

Factors decreasing likelihood of referral (decreasing order of importance)

Atypical patient (i.e. young/active); doesn't fit AD profile Patient needs dementia clinically confirmed as soon as possible for legal/social/support reasons AD symptoms unclear (unverifiable with tools available in primary care) for that specific patient Underlying conditions/co‐morbidities AD history in family PCP does not have access to confirmatory tests at secondary care but believes in their need for diagnosis Fast progressing cognitive impairment PCP is overburdened and wants to pass patient on Direct pressure from family to take action

No DMT available (nothing could be done anyway) Patient seen as a ‘lost cause’ – too old/too frail/AD detected too late to provide meaningful support Symptoms judged clear enough to confirm the diagnosis only from cognitive/other tests available to PCP directly Patient unwillingness to proceed with diagnosing Lack of resources; further referral as a burden to the system Lack of funding in secondary care (long wait time/queues) Lack of belief in amyloidosis for AD diagnosis – PCP having all the tools to diagnose themselves

Note: Initial qualitative physician/payer survey (fieldwork: November 16 to December 3, 2021).

Abbreviations: AD, Alzheimer's disease; DMT, disease‐modifying treatment; PCP, primary care practitioner.