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Issues in Prescriptive Authority for Psychologists

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					Issues in Prescriptive
Authority for Psychologists

Robert E. McGrath
Fairleigh Dickinson University
Initial Motivating Factors
   Shortage of psychiatric care (Hartley et al.,
    1999)
    – 14.6 psychiatrists per 100,000 in urban areas,
      3.9 per 100,000 in rural areas
    – 20 psychologists per 100,000 in urban areas, 15
      per 100,000 in rural areas
   Reliance on primary care
    – PCPs write 70% of prescriptions for
      psychotropics (Beardsley et al., 1988)—
      admittedly out of date
    – 50% of office visits where psychotropics were
      prescribed involved PCPs, 25% involved
      psychiatrists (Pincus et al., 1998)
Psychologists’ Current
Involvement
   Vandenbos & Williams (2000)
    – 43% of psychologists’ current patients
      were using psychotropic medication
    – 94% reported they had consulted with
      physicians about changing the medication
      of their patients
    – 87% indicated they had been involved in
      medication decision-making for some
      portion of their caseload
Possible Benefits to
Patients
   One-stop shopping
   Improved monitoring of compliance/side effects
   Prescription by someone trained in psychiatric
    diagnosis
   Better integration of psychotherapy and
    pharmacotherapy
   Less overmedication/polypharmacy
   Increased awareness of pseudo-psychiatric medical
    conditions
   Fewer mixed messages about treatment
Possible Benefits to
Society
   Reduced costs
   Reduced use of medications
Brief History
   1984: Sen. Daniel Inouye to Hawaii Psychological
    Association: Psychologists should pursue
    prescriptive authority (RxA)
   1989: Dept. of Defense creates
    Psychopharmacology Demonstration Project (PDP),
    which trains 10 psychologists to prescribe
   1996: APA approves training model and model
    legislation for RxA
   RxA in Guam (1998), New Mexico (2002), Louisiana
    (2004)
   12 other states have submitted legislation of some
    sort
APA Training Model
   Level 1: Predoctoral
    – One course
    – Well-defined curriculum
   Level 2: Collaborative practice
    – Postdoctoral
    – Didactic (300-350 hours)
   Level 3: Independent practice
    – Post-licensure
    – Didactic + Practica
Training Programs

   4 master’s programs, 5 certificate
    programs
   3-4 offer distance options
   450+ hours, 30+ graduate credits
New Mexico Law

   450 didactic hours
   80-hour practicum in physical
    assessment and pathophys
   400-hour practicum with ≥ 100
    patients supervised by a physician
   Pass national exam
   2 years supervised prescribing, then
    independent practice with formulary
Louisiana Law

   Post-doctoral master’s degree “or
    equivalent”
   Pass national exam
   Prescribe only in collaboration with
    attending physician
Concerns: Insufficient
Preparation
   PDP curriculum cut 50% and would
    have been cut further.
   PDP graduates helped design current
    programs.
   Goal of training is not lifetime training;
    it is building basic competencies.
   The most important issue is safety.
Concerns: Safety

   PDP grads have prescribed for 10 years; #
    serious adverse events: 0
   1988-1992: 1.6 million mental health
    treatments by American Biodyne with
    psychologist case managers with 130 hours
    of training in psychopharm; rate of
    prescribing dropped from 68% to 13%
   2005: 30 psychologists in LA wrote 9,345
    prescriptions; # adverse events: 0
Concerns: Loss of Identity

   Post-doctoral training
   Involvement of non-clinicians
   Development of practice guidelines
    early in the process
Fairleigh Dickinson
M.S. Program in Clinical
Psychopharmacology



    www.rxpsychology.com

				
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posted:8/29/2012
language:English
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