Issues in Prescriptive Authority for Psychologists

1
Issues in Prescriptive Authority for
Psychologists

• Robert E. McGrath
• Fairleigh Dickinson University

2
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  (Beardsley et al., 1988)admittedly out of date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)

3
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

4
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

5
Possible Benefits to Society

• Reduced costs
• Reduced use of medications

6
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

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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

8
Training Programs

• 4 masters programs, 5 certificate programs
• 3-4 offer distance options
• 450 hours, 30 graduate credits

9
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

10
Louisiana Law

• Post-doctoral masters degree or equivalent
• Pass national exam
• Prescribe only in collaboration with attending
  physician

11
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.

12
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

13
Concerns Loss of Identity

• Post-doctoral training
• Involvement of non-clinicians
• Development of practice guidelines early in the
  process

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Fairleigh DickinsonM.S. Program in Clinical
Psychopharmacology

• www.rxpsychology.com