New Faculty
Ira Wilson Professor of Community Health Credit: Mike Cohea/Brown University

Ira Wilson
Professor of Community Health

By David Orenstein  |  September 1, 2010  |  Email to a friend

Prescriptions are often the best — and sometimes the only — option for treating disease, so it’s a big problem in health care that roughly 50 percent of people with chronic conditions lapse in taking their medicine. As a practicing primary care physician and newly appointed professor of community health, Ira Wilson knows how hard it can be for doctors to convince their patients to get back on track. Much of his recent research is dedicated to finding a way that works.

“Even though our medications have gotten better and better over the last 20–30 years, patients’ willingness and ability to take them has not improved,” Wilson says. “My research is focused on what to do to improve the quality of physician–patient dialogue about medications.”

In a study of HIV-positive patients that Wilson published last year while a medical professor at Tufts University, he and collaborators became figurative flies on the wall both in patients’ medicine cabinets and in doctors’ offices. With a chip in the medicine bottles that tracked whether and when they were opened, they could tell who seemed to be taking their medicine. With recorders in doctor’s offices, they could directly observe the conversations doctors had or didn’t have with patients about the issue.

Wilson’s hope was that if he told doctors which patients were taking their medicine, they could be more effective in improving adherence. Instead, he found that doctors who had that information were about twice as likely to talk with their patients about taking their medicine — but the patients were no more likely to pop their pills despite those conversations.

“What we learned, because we could actually look at what was happening during those discussions, was that mostly what was going on the doctor’s part were directives, such as ‘Don’t do this, don’t do that,’ and many of them had a scolding quality to them,” Wilson said. “Even in HIV care, where doctors are more convinced than with almost any other condition that adherence is very critical, doctors don’t have really great skills in that area. Why would they? Physicians are never trained in that area.”

At Brown, Wilson will begin a federally funded project to give doctors better training, for instance in how to create a more comfortable environment for patients to express and solve their adherence problems.

As he continues his research and moves his practice from Boston to the VA Medical Center in Providence, Wilson will also take a leadership role in managing the fast growth of the Department of Community Health, which welcomes three new professors this fall. He will head the section on health services, policy, and practice.

The post reflects Wilson’s experience as a longtime professor at Tufts and as outcomes and biostatistics core director at the Center for AIDS Research, run by Tufts, Brown and Lifespan. At Brown, Wilson says, he’ll have the privilege of building on excellence.

“In public health and in health services research, Brown is an utterly outstanding institution with a tremendous national reputation,” Wilson said.

As a physician, professor, and section head, Wilson is fundamentally motivated by a broad but intense interest in how the health care system works and how it can work better. Knowing how befuddling the subject can be to non-experts, the award-winning teacher is also eager to get into the classroom next spring to teach the undergraduate course, “PHP 310: Health Care in the United States.”

It’s probably fair to say that students in the class will be gently and constructively advised to maintain full adherence to the syllabus he prescribes.

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