July 27, 2001
Robert Wood Johnson
Foundation Selects Allen L. Gifford, M.D.
For Generalist Physician Scholar Program
|“For some time I’ve been interested in finding ways that primary care physicians can help patients learn to cope better with chronic disease,” Gifford says.|
Allen L. Gifford, M.D., an assistant professor of medicine in the University of California, San Diego (UCSD) School of Medicine, and a physician with the VA San Diego Healthcare System, has been selected by the Robert Wood Johnson Foundation for its 2001 Generalist Physician Faculty Scholar Award. The program awards $300,000 over a 4-year period to support and develop generalist physicians, also known as family practitioners, general internists and general pediatricians.
Noting that the proportion of generalist physicians in the United States is well below that of other industrialized nations, Gifford says “too few generalists and too many specialists create a barrier to achieving access to basic health care for Americans and contribute to the high cost of health care in the United States. The Generalist Physician Faculty Scholar Award from the Robert Wood Johnson Foundation offers career development for generalist physicians and support for their research.”
Gifford’s research focuses on how patients with chronic disease manage and adhere their own complicated disease treatment regimens. His current work is on improving physician-patient communication, and on training providers to educate their patients.
“For some time I’ve been interested in finding ways that primary care physicians can help patients learn to cope better with chronic disease,” Gifford says.
His research includes learning to identify patients in clinical care who are having trouble adhering to their medications, and developing clinic-based interventions to improve physician-patient communication and collaboration in chronic disease care. Gifford’s studies to date have been with patients with HIV infection. He notes that many patients have great difficulty taking the multiple medications needed to control HIV.
“Many don’t understand that they could become resistant to HIV drugs if they don’t take them on a regular basis,” he says. “Other patients have trouble fitting complicated drug regimens into their daily lives. Many of those in care have great need for education and support.”
In a 1998-2000 study designed by Gifford, self-care skills were taught to HIV patients in group sessions led by a nurse and an HIV-infected peer educator. While this approach was promising, Gifford says it was difficult to use group teaching in many clinical care settings because of difficulties scheduling meetings of patient groups.
Gifford believes he found a promising patient education approach by working with pharmacists trained to help patients who need better medication-taking knowledge and skills. As core members of the primary care team, these pharmacists question patients about their dosing patterns, motivate patients to adhere, and problem-solve with the patients to help them integrate taking of medications into their established daily routines.
“They ask what times of day patients have tried to take their medications and why it is difficult to remember medications at different times of the day. Pharmacists can then determine what activities may interfere with taking or remembering medications. Then, they help patients set up a specific schedule, and help them identify ways to remind themselves about the medicines” Gifford says.
This program – called the ACE (Adherence Care Enhancement) Program – is currently being evaluated in a study at HIV clinics in 4 VA hospitals in the western United States. ACE pharmacists are at VA Medical Centers in San Diego, and in West Los Angeles, Palo Alto, and Tucson, Arizona, with medication adherence at intervention sites compared with control sites.
Funding from the Robert Wood Johnson Foundation will help Dr. Gifford expand his research by studying methods to improve adherence in patients with chronic heart disease. A pilot study will begin soon, followed by a three- to four-year intervention program for adherence to heart disease medications.
“Medications that are now widely available are highly effective for preventing heart attacks and death in patients with known heart disease. But many heart disease patients still do poorly. Cardiac patients need help in understanding that treatment can greatly improve their health, but that good self-care is challenging, and takes effort.” Gifford notes that many heart patients may minimize their conditions, and take a passive rather than an active role in managing illness.
At the VA San Diego Healthcare System medical center in La Jolla, Gifford will collaborate with pharmacist colleagues to further refine and test primary care models to teach cardiac patients about adhering to medications.
Gifford is one of 14 physicians in the United States to receive this award from the Robert Wood Johnson Foundation to support research, teaching, and other scholarship in clinical generalism.
Based in Princeton, New Jersey, the Robert Wood Johnson Foundation is the nation’s largest philanthropy devoted exclusively to health and health care. It concentrates its grant making in three goal areas: to assure that all Americans have access to basic health care at reasonable cost; to improve care and support for people with chronic health conditions; and to reduce the personal, social and economic harm caused by substance abuse – tobacco, alcohol, and illicit drugs.
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Media Contact: Sue Pondrom
UCSD Health Sciences Communications
Cindy C. Butler
VA San Diego Healthcare System
UCSD Health Sciences Communications HealthBeat: http://health.ucsd.edu/news/