{"id":"https://openalex.org/W7220963142","doi":"https://doi.org/10.3389/fpubh.2026.1923342","title":"Barriers to health care access in a federally under-resourced system: experiences of Alzheimer\u2019s disease and related dementias patients and caregivers in Puerto Rico","display_name":"Barriers to health care access in a federally under-resourced system: experiences of Alzheimer\u2019s disease and related dementias patients and caregivers in Puerto Rico","publication_year":2026,"publication_date":"2026-10-08","ids":{"openalex":"https://openalex.org/W7220963142","doi":"https://doi.org/10.3389/fpubh.2026.1923342","pmid":"https://pubmed.ncbi.nlm.nih.gov/42923508","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13687668"},"language":"en","primary_location":{"id":"doi:10.3389/fpubh.2026.1923342","doi":"https://doi.org/10.3389/fpubh.2026.1923342","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1923342","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1923342/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1923342/pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5078999288","display_name":"Mariela Torres-Cintr\u00f3n","orcid":"https://orcid.org/0000-0002-9485-9486","observed_orcids":["https://orcid.org/0000-0002-9485-9486"]},"institutions":[{"id":"https://openalex.org/I158818660","display_name":"University of Puerto Rico, Medical Sciences Campus","ror":"https://ror.org/00h25w961","country_code":"PR","type":"education","lineage":["https://openalex.org/I158818660","https://openalex.org/I200399037"]}],"countries":["PR"],"is_corresponding":true,"raw_author_name":"Mariela Torres-Cintr\u00f3n","raw_affiliation_strings":["University of Puerto Rico, Medical Sciences Campus"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Puerto Rico, Medical Sciences Campus","institution_ids":["https://openalex.org/I158818660"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5049867470","display_name":"Alexandra Mendoza-Graf","orcid":"https://orcid.org/0000-0003-2529-7085","observed_orcids":["https://orcid.org/0000-0003-2529-7085"]},"institutions":[{"id":"https://openalex.org/I1309849503","display_name":"RAND Corporation","ror":"https://ror.org/00f2z7n96","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I1309849503"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Alexandra Mendoza-Graf","raw_affiliation_strings":["RAND"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"RAND","institution_ids":["https://openalex.org/I1309849503"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5101651597","display_name":"Gabriela Castro","orcid":"https://orcid.org/0000-0003-2521-1923","observed_orcids":["https://orcid.org/0000-0003-2521-1923"]},"institutions":[{"id":"https://openalex.org/I1309849503","display_name":"RAND Corporation","ror":"https://ror.org/00f2z7n96","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I1309849503"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Gabriela Castro","raw_affiliation_strings":["RAND"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"RAND","institution_ids":["https://openalex.org/I1309849503"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5038660207","display_name":"Gilberto Ramos-Valencia","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I158818660","display_name":"University of Puerto Rico, Medical Sciences Campus","ror":"https://ror.org/00h25w961","country_code":"PR","type":"education","lineage":["https://openalex.org/I158818660","https://openalex.org/I200399037"]}],"countries":["PR"],"is_corresponding":false,"raw_author_name":"Gilberto Ramos-Valencia","raw_affiliation_strings":["University of Puerto Rico, Medical Sciences Campus"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Puerto Rico, Medical Sciences Campus","institution_ids":["https://openalex.org/I158818660"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5111441973","display_name":"Marielena Lara","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1309849503","display_name":"RAND Corporation","ror":"https://ror.org/00f2z7n96","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I1309849503"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Marielena Lara","raw_affiliation_strings":["RAND"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"RAND","institution_ids":["https://openalex.org/I1309849503"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5032477552","display_name":"Ivonne Z. Jim\u00e9nez\u2010Vel\u00e1zquez","orcid":"https://orcid.org/0000-0002-9943-1657","observed_orcids":["https://orcid.org/0000-0002-9943-1657"]},"institutions":[{"id":"https://openalex.org/I158818660","display_name":"University of Puerto Rico, Medical Sciences Campus","ror":"https://ror.org/00h25w961","country_code":"PR","type":"education","lineage":["https://openalex.org/I158818660","https://openalex.org/I200399037"]}],"countries":["PR"],"is_corresponding":false,"raw_author_name":"Ivonne Z. Jim\u00e9nez-Vel\u00e1zquez","raw_affiliation_strings":["University of Puerto Rico, Medical Sciences Campus"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Puerto Rico, Medical Sciences Campus","institution_ids":["https://openalex.org/I158818660"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5121094851","display_name":"Ilka Rios","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I158818660","display_name":"University of Puerto Rico, Medical Sciences Campus","ror":"https://ror.org/00h25w961","country_code":"PR","type":"education","lineage":["https://openalex.org/I158818660","https://openalex.org/I200399037"]}],"countries":["PR"],"is_corresponding":false,"raw_author_name":"Ilka Rios","raw_affiliation_strings":["University of Puerto Rico, Medical Sciences Campus"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Puerto Rico, Medical Sciences Campus","institution_ids":["https://openalex.org/I158818660"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5028916437","display_name":"Johan Hernandez Santiago","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I158818660","display_name":"University of Puerto Rico, Medical Sciences Campus","ror":"https://ror.org/00h25w961","country_code":"PR","type":"education","lineage":["https://openalex.org/I158818660","https://openalex.org/I200399037"]}],"countries":["PR"],"is_corresponding":false,"raw_author_name":"Johan Hernandez-Santiago","raw_affiliation_strings":["University of Puerto Rico, Medical Sciences Campus"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Puerto Rico, Medical Sciences Campus","institution_ids":["https://openalex.org/I158818660"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5042997724","display_name":"Beverly A. Weidmer","orcid":"https://orcid.org/0000-0002-0376-9777","observed_orcids":["https://orcid.org/0000-0002-0376-9777"]},"institutions":[{"id":"https://openalex.org/I1309849503","display_name":"RAND Corporation","ror":"https://ror.org/00f2z7n96","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I1309849503"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Beverly Weidmer","raw_affiliation_strings":["RAND"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"RAND","institution_ids":["https://openalex.org/I1309849503"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5069912764","display_name":"Justin W. Timbie","orcid":"https://orcid.org/0000-0002-9955-5270","observed_orcids":["https://orcid.org/0000-0002-9955-5270"]},"institutions":[{"id":"https://openalex.org/I1309849503","display_name":"RAND Corporation","ror":"https://ror.org/00f2z7n96","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I1309849503"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Justin W. Timbie","raw_affiliation_strings":["RAND"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"RAND","institution_ids":["https://openalex.org/I1309849503"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5078999288"],"corresponding_institution_ids":["https://openalex.org/I158818660"],"apc_list":{"value":3150,"currency":"CHF","value_usd":3801},"apc_paid":{"value":3150,"currency":"CHF","value_usd":3801},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.75946446,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":null,"first_page":"1923342","last_page":"1923342"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10009","display_name":"Dementia and Cognitive Impairment Research","score":0.975600004196167,"subfield":{"id":"https://openalex.org/subfields/2738","display_name":"Psychiatry and Mental health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10009","display_name":"Dementia and Cognitive Impairment Research","score":0.975600004196167,"subfield":{"id":"https://openalex.org/subfields/2738","display_name":"Psychiatry and Mental health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.008899999782443047,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10272","display_name":"Mental Health Treatment and Access","score":0.0024999999441206455,"subfield":{"id":"https://openalex.org/subfields/2738","display_name":"Psychiatry and Mental health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/alzheimer-s-disease-and-related-dementias","display_name":"Alzheimer's disease and related dementias","score":0.9580000042915344},{"id":"https://openalex.org/keywords/barriers-to-care","display_name":"barriers to care","score":0.6209999918937683},{"id":"https://openalex.org/keywords/caregivers","display_name":"caregivers","score":0.8429999947547913},{"id":"https://openalex.org/keywords/puerto-rico","display_name":"Puerto Rico","score":0.699999988079071},{"id":"https://openalex.org/keywords/medicare-advantage","display_name":"Medicare Advantage","score":0.4650000035762787},{"id":"https://openalex.org/keywords/care-coordination","display_name":"care coordination","score":0.8920000195503235},{"id":"https://openalex.org/keywords/waiting-time","display_name":"waiting time","score":0.699999988079071},{"id":"https://openalex.org/keywords/access-to-specialized-care","display_name":"access to specialist care","score":0.703000009059906},{"id":"https://openalex.org/keywords/andersen-behavioral-model-of-health-services-use","display_name":"Andersen Behavioral Model of Health Services Use","score":0.8650000095367432},{"id":"https://openalex.org/keywords/health-equity","display_name":"health equity","score":0.5379999876022339},{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.7400000095367432},{"id":"https://openalex.org/keywords/federal-health-policy","display_name":"federal health policy","score":0.5350000262260437}],"concepts":[{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.7792999744415283},{"id":"https://openalex.org/C2779483572","wikidata":"https://www.wikidata.org/wiki/Q83030","display_name":"Dementia","level":3,"score":0.7177000045776367},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.616100013256073},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.5339000225067139},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.516700029373169},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.4936000108718872},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.3926999866962433},{"id":"https://openalex.org/C2779703844","wikidata":"https://www.wikidata.org/wiki/Q760125","display_name":"Reimbursement","level":3,"score":0.3499999940395355},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.335099995136261},{"id":"https://openalex.org/C2250968","wikidata":"https://www.wikidata.org/wiki/Q1512929","display_name":"Health equity","level":3,"score":0.3321000039577484},{"id":"https://openalex.org/C3019007097","wikidata":"https://www.wikidata.org/wiki/Q7834462","display_name":"Continuum of care","level":3,"score":0.32839998602867126},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3260999917984009},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.32429999113082886},{"id":"https://openalex.org/C190248442","wikidata":"https://www.wikidata.org/wiki/Q839486","display_name":"Qualitative research","level":2,"score":0.30720001459121704},{"id":"https://openalex.org/C2780877353","wikidata":"https://www.wikidata.org/wiki/Q2518253","display_name":"Health services research","level":3,"score":0.29760000109672546},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.2928999960422516},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.2912999987602234},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.28679999709129333},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.27309998869895935},{"id":"https://openalex.org/C78491826","wikidata":"https://www.wikidata.org/wiki/Q3045352","display_name":"Social determinants of health","level":3,"score":0.26420000195503235},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.26269999146461487},{"id":"https://openalex.org/C2778900529","wikidata":"https://www.wikidata.org/wiki/Q2827779","display_name":"Family caregivers","level":2,"score":0.2623000144958496},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.257999986410141}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000369","descriptor_name":"Aged, 80 and over","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000544","descriptor_name":"Alzheimer Disease","qualifier_ui":"Q000628","qualifier_name":"therapy","is_major_topic":true},{"descriptor_ui":"D003704","descriptor_name":"Dementia","qualifier_ui":"Q000628","qualifier_name":"therapy","is_major_topic":true},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006297","descriptor_name":"Health Services Accessibility","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007407","descriptor_name":"Interviews as Topic","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011647","descriptor_name":"Puerto Rico","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017028","descriptor_name":"Caregivers","qualifier_ui":"Q000523","qualifier_name":"psychology","is_major_topic":true},{"descriptor_ui":"D017028","descriptor_name":"Caregivers","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D036301","descriptor_name":"Qualitative Research","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":4,"locations":[{"id":"doi:10.3389/fpubh.2026.1923342","doi":"https://doi.org/10.3389/fpubh.2026.1923342","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1923342","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1923342/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},{"id":"pmid:42923508","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42923508","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in public health","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13687668","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13687668/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Front Public Health","raw_type":"Text"},{"id":"pmh:oai:doaj.org/article:057a88bdbc5d4f73ac381fc5423b7cfc","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/057a88bdbc5d4f73ac381fc5423b7cfc","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Frontiers in Public Health, Vol 14 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.3389/fpubh.2026.1923342","doi":"https://doi.org/10.3389/fpubh.2026.1923342","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1923342","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1923342/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9763000011444092},{"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities","score":0.9629999995231628}],"study_designs":[],"awards":[{"id":"https://openalex.org/G9000873498","display_name":"Alliance for Clinical and Translational Research (Alliance)","funder_award_id":"P50GM133807","funder_id":"https://openalex.org/F4320337354","funder_display_name":"National Institute of General Medical Sciences"},{"id":"https://openalex.org/G9000895211","display_name":"Primary Care Transformation in Puerto Rico's Physician Organizations Following Hurricane Maria","funder_award_id":"R01AG075508","funder_id":"https://openalex.org/F4320337337","funder_display_name":"National Institute on Aging"}],"funders":[{"id":"https://openalex.org/F4320306219","display_name":"Alzheimer's Association","ror":"https://ror.org/0375f4d26"},{"id":"https://openalex.org/F4320332161","display_name":"National Institutes of Health","ror":"https://ror.org/01cwqze88"},{"id":"https://openalex.org/F4320337337","display_name":"National Institute on Aging","ror":"https://ror.org/049v75w11"},{"id":"https://openalex.org/F4320337354","display_name":"National Institute of General Medical Sciences","ror":"https://ror.org/04q48ey07"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7220963142.pdf","grobid_xml":"https://content.openalex.org/works/W7220963142.grobid-xml"},"referenced_works_count":24,"referenced_works":["https://openalex.org/W1949606258","https://openalex.org/W1971241322","https://openalex.org/W2053154970","https://openalex.org/W2068155640","https://openalex.org/W2079637497","https://openalex.org/W2142225512","https://openalex.org/W2345188768","https://openalex.org/W2605472059","https://openalex.org/W2783102781","https://openalex.org/W3046275966","https://openalex.org/W3090136557","https://openalex.org/W3125018657","https://openalex.org/W3158424684","https://openalex.org/W3208645186","https://openalex.org/W3209095987","https://openalex.org/W4223474220","https://openalex.org/W4294084849","https://openalex.org/W4296193064","https://openalex.org/W4362634771","https://openalex.org/W4401165854","https://openalex.org/W4402169020","https://openalex.org/W4405968376","https://openalex.org/W4411055786","https://openalex.org/W7172330777"],"related_works":["https://openalex.org/W7116877276","https://openalex.org/W7117237046","https://openalex.org/W7118093766","https://openalex.org/W7196963609","https://openalex.org/W4376641274","https://openalex.org/W2899799032","https://openalex.org/W2733000306","https://openalex.org/W4323809973","https://openalex.org/W4396835713","https://openalex.org/W4410694871"],"abstract_inverted_index":{"Background:":[0],"Alzheimer's":[1,81],"disease":[2,82],"and":[3,20,83,86,106,133,144,161,163,224,237,244],"related":[4,84],"dementias":[5,85],"have":[6],"reached":[7],"crisis":[8],"proportions":[9],"in":[10,25,40,178,204,207],"Puerto":[11,90,208],"Rico,":[12],"where":[13],"the":[14,26,37,41,59,155],"proportion":[15],"of":[16,36,123,157,174,195,246],"residents":[17],"aged":[18],"65":[19],"older":[21,213],"has":[22],"nearly":[23,149],"doubled":[24],"past":[27],"decade,":[28],"from":[29],"11":[30],"to":[31,50,74,189,252],"21%,":[32],"making":[33],"it":[34],"one":[35],"oldest":[38],"populations":[39],"Americas.":[42],"Despite":[43,172],"near-universal":[44],"insurance":[45,181],"coverage,":[46],"families":[47],"frequently":[48],"struggle":[49],"translate":[51,185],"potential":[52,170],"access":[53,77,188,196,255],"into":[54,186],"actual":[55],"care":[56,76,146,206,222,248],"utilization,":[57],"yet":[58],"systemic":[60,199],"barriers":[61,73,128,197],"driving":[62],"this":[63,257],"gap":[64],"remain":[65],"poorly":[66],"documented.":[67],"Methods:":[68],"This":[69],"qualitative":[70],"study":[71],"examined":[72],"dementia":[75,205,216],"among":[78],"individuals":[79],"with":[80,96,127,215],"their":[87],"caregivers":[88],"across":[89,130],"Rico.":[91,209],"Semi-structured":[92],"interviews":[93],"were":[94],"conducted":[95],"51":[97],"patient-caregiver":[98],"dyads":[99],"representing":[100],"19":[101],"municipalities":[102],"between":[103],"December":[104],"2023":[105],"November":[107],"2024.":[108],"Data":[109],"was":[110],"analyzed":[111],"using":[112],"a":[113],"directed":[114],"content":[115],"analysis":[116],"approach":[117],"guided":[118],"by":[119],"Andersen's":[120],"Behavioral":[121],"Model":[122],"Health":[124,210],"Services":[125],"Use,":[126],"categorized":[129],"structural,":[131],"process-level,":[132],"enabling":[134],"resource":[135],"domains.":[136],"Results:":[137],"Extended":[138],"waiting":[139],"times,":[140],"limited":[141],"specialist":[142],"access,":[143],"inadequate":[145],"coordination":[147],"affected":[148],"all":[150],"families.":[151],"Structural":[152],"underinvestment,":[153],"particularly":[154],"absence":[156],"Medicaid":[158,234],"long-term":[159,235],"services":[160,236],"supports":[162,238],"restrictive":[164],"Medicare":[165,179],"Advantage":[166],"networks,":[167],"further":[168],"constrained":[169],"access.":[171],"94%":[173],"participants":[175],"being":[176],"enrolled":[177],"Advantage,":[180],"coverage":[182],"did":[183],"not":[184],"realized":[187],"needed":[190],"services.":[191],"Conclusion:":[192],"The":[193],"universality":[194],"reflects":[198],"rather":[200],"than":[201],"individual-level":[202],"failures":[203],"systems":[211],"serving":[212],"adults":[214],"should":[217],"prioritize":[218],"open-access":[219],"scheduling,":[220],"integrated":[221],"coordination,":[223],"routine":[225],"screening":[226],"for":[227,240,256],"social":[228],"needs.":[229],"Federal":[230],"policy":[231],"reforms,":[232],"including":[233],"parity":[239],"United":[241],"States":[242],"territories":[243],"expansion":[245],"dementia-specific":[247],"models,":[249],"are":[250],"essential":[251],"achieving":[253],"equitable":[254],"population.":[258]},"counts_by_year":[],"updated_date":"2026-11-05T12:25:35.769452","created_date":"2026-10-09T00:00:00"}