Kentucky Psychological Association. Taskforce on Psychopharmacology. Presentation to the KPA Board of Directors June 2004

Transcription

1 Kentucky Psychological Association Taskforce on Psychopharmacology Presentation to the KPA Board of Directors June 2004

2 Overview of Presentation Introduction of Task Force Members (5 min.) Summary of 12/13/02 Board Action (5 min.) Reason Action is needed by KPA Board (5 min.) Arguments against Prescriptive Authority (10 min.) Why is there a need for psychologists to prescribe? (5 min.) Information supporting Prescriptive Authority (10 min.) Available Training Programs (10 min.) Other Supporting Facts (5 min.) Summary of National Activity (10 min.) APA Position on Prescriptive Authority (5 min.) ASPPB Position (5 min.) Discussion/Question and Answer Session (30 min.) Please note time limits: we hope to cover a lot of material prior to the Discussion/ Question and Answer sesion 2

3 Taskforce Members Deborah Hino, KPA Past-President President (Jefferson) John James, Spalding Univ. (Jefferson) Owen Nichols, Chair Pauline Lloyd, Western St. Hosp., Western KY Internship Consortium (Western) Andy Meyer, Spalding Univ., Health Psychology (Jefferson) Bryan Carter, UofL, Child/Adolescent (Jefferson) Eva Markham, UofL, Families/Children (Jefferson) Edward Muntel, North Key Community Sandra D Angelo, UK, Pediatric (Fayette) Dan Luchtefeld, Eastern State (Fayette) John Fidanza, Private Practice (Jefferson) Brenda Hughes, Community Mental Health (Eastern) George Martinez, Masters Level, Guardianship (Central) Peter Ganshirt, Private Practice (Northern) Richard Lewine, Uof L, Dept. of Psych. (Jefferson) Robin Sublett, Corrections, (Jefferson) Mental Health (Northern) Jim Shields, Private Practice (Jefferson Tamara Knox, Primary Care (Eastern) Linda Rice, REACH of Louisville/ Jefferson County Internship Consortium (Jefferson) 3

4 Kentucky Psychological Association Task Force on Psychopharmacology Task Force on Psychopharmacology created December 2002 as an on-going entity of the Kentucky Psychological Association, with responsibility for providing: Information Education Opportunities for Discussion 4

5 Kentucky Psychological Association Task Force on Psychopharmacology GOAL: Build capacity and consensus for action to secure prescriptive authority for Kentucky psychologists 5

6 Task Force Activities Convention Activities Panel discussion sessions Anita Brown invited address Open Forum Information Booth Regional information/discussion forums Information on training programs that meet standards for national Exam in Psychopharmacology Articles/Information in Kentucky Psychologist Monitoring activities in other states 6

7 Reason for Action by KPA Board Two complimentary absolutely necessary factors: Psychologists must pursue the training to demonstrate that there is a trained group of providers willing to serve the public if a statute is passed. KPA must be actively pursuing prescriptive authority legislation before most Kentucky psychologists would be willing to make the commitment to obtaining the advanced training in psychopharmacology. 7

8 Arguments Against Prescriptive Authority for Psychologists Only physicians can prescribe safely. Psychologists will become greedy pill pushers/junior psychiatrists Prescriptive Authority will change the identify of psychology. Liability insurance premiums will increase drastically for all psychologists. Prescription privileges will require the core courses of graduate schools to change. All psychologists will have to be retrained to prescribe. 8

9 Arguments Against Prescriptive Authority for Psychologists There is no data to support any of these arguments against prescriptive authority. 9

10 What is the Goal in Seeking Prescriptive Authority? To provide comprehensive quality care to consumers of mental health services To provide accessibility to mental healthcare for those who may benefit from psychotropic medication To provide a reduction in cost by the elimination of wasteful and inconvenient duplication of services To address quality of care through coordination of care and continuity of treatment for those seeking both Medication and other Mental Health services 10

11 Is there a need? (Con t.) Approx 30% of US population suffers from mental illness or addictive disorder. One of every two people who need mental health services do not receive them Presidential Commission on Mental Health: the US is in a mental health crisis, due to lack of accessibility (1999 Surgeon General s report on Mental Health) 11

12 Is there a need for Psychologists to obtain Prescriptive Authority? In 1990,, a joint publication of the Public Citizen Health Research Group and the National Alliance for the Mentally Ill stated: Since psychiatrists have abandoned the public sector, psychologists,, physician assistants, and nurse practitioners should be given special training and allowed to prescribe psychiatric medications. 12

13 History of Mental Health Treatment: Why access to medication is so important Prior to advent of psychotropic drugs, over ½ million adults institutionalized in the US. Dropped to 100,000 with introduction of antipsychotic medications In Kentucky, over 8,000 were confined to state- operated psychiatric hospitals Currently, less that 500 adults are in state operated facilities 13

14 Quality of Care: Primary Care and Psychiatry Only 17% of all psychotropic drugs are prescribed by a psychiatrist. From , psychotropic meds prescribing has increased by over 40% and continues to rise Between , 92, med students entering psychiatric residencies dropped by 29% 14

15 Supporting Facts: the Practice of Medicine Only 17% of all psychotropic drugs are prescribed by a psychiatrist. 83% are prescribed by a primary care physician or ARNP who may or may not have adequate training in psychotropic drugs (American Journal of Psychiatry) From , 1995, psychotropic medication prescribing has increased by over 40% and continues to rise. Between medical school students entering psychiatric residency programs dropped by 29% A psychiatric residency is considered to be one of the least desirable and least competitive placements in the field of medicine (National Residency Matching Program) 15

16 Supporting Facts: Kentucky Random sample of 70 adult psychiatric patients living in Western KY asked to identify their top unmet needs: Access to Psychiatric Services Medication availability Transportation Substance abuse programming Housing 16

17 Supporting Facts: Kentucky Informal survey of 14 Kentucky cities Time from call to first appointment Average: 7 weeks. Typical wait: 8 weeks Range: weeks October

18 Supporting Facts: Psychiatric Services in Kentucky Community Mental Health Centers Typical waiting time to first Psychiatric appointment: months Follow up schedule: months Time spent with psychiatrist: Initial evaluation: 30 minutes Follow up: 15 minutes Therapy and Psychosocial Rehab services generally provided by non-physicians on separate date/time increasing cost and no-shows 18

19 Supporting Facts: Psychiatric Services in Kentucky Correctional System Total inmate population: 11,147 Percentage on psychiatric medication: 15% (1,672) Effective number of psychiatrists 2.2 FTE One psychiatrist per 5,573 inmates One psychiatrist per 836 inmates on medication Effective number of psychologists: ASK LIZ 19

20 KPA membership Interest/Opposition 1993: KPA survey found 62% of respondents believed Prescriptive Authority would be good for the profession of Psychology 2002: KPA survey found 62% believed prescriptive authority would be good for the profession of psychology, 86% agreed that psychologists interested in obtaining training and certification should have the right to pursue this goal 82% agreed to support KY psychologists who wish to obtain training to prescribe 2003 KPA Convention 52 signed request for KPA to support the pursuit of prescriptive authority; two people objected to KPA supporting this initiative 2004 Survey results to be presented at June Board meeting 20

21 Available Training Programs Post-doctoral master s degree in psychopharmacology OR Certificate of Continuing Education Cost: $7,700-$13,000, $13,000, plus travel, books, etc. Coursework: graduate credit hours; hours of instruction months of continuous study 21

22 Available Training Programs California School of Professional Psychology/ Alliant International University Fairleigh Dickinson University Massachusetts School of Professional Psychology Nova Southeastern University Prescribing Psychologists Register Southwestern Institute of for the Advancement of Psychotherapy The Pharmacology Institute 22

23 Comparison of post-secondary secondary education across disciplines Psychologists: years Psychiatrists: years Nurse Practitioners: Optometrists: Dentists: Podiatrists: 6 years 8 years 8 years 8 years 23

24 Comparison of Vanderbilt Nursing Bridge Program Does not require a Bachelors Degree in nursing Total 78 semester hours (2 year program) Graduates eligible to prescribe as ARNPs 24

25 Masters in Psychopharmacology Doctorate in Psychology Licensure as Psychologist Full year pre-graduate internship Full year post-doctoral supervision 30 graduate semester hours Psychologists seeking prescriptive authority have significantly more preparation than some other professionals with prescriptive authority 25

26 Other Supporting Facts 1992: 64% of hospital affiliated psychologists report collaboration with physicians regarding medication type and dose 2000: US Surgeon General David Satcher, MD, PhD. stated, If we can demonstrate training to prescribe, then they should be allowed to prescribe 26

27 Other Supporting Facts The average medical student receives 99 hours of pharmacology training Psychologists seeking prescriptive authority complete approximately 225 hours training in pharmacology AND 250+ hours in neuroanatomy, neurophysiology, pharmacotherapeutics, physical assessment, and lab assessment 27

28 United States Department of Defense Project Nationally, when an individual sees psychiatrist or primary care physician for mental health issues, he/she receives prescription 90% of time DOD research based on random assignment of patients: Psychologists wrote prescriptions for 10-30% of patients Psychiatrists wrote prescriptions for nearly 100% of patients Biodyne researchers found that when care was managed by psychologist, 68% of clients on medication at the start of study reduced to 13 % with no complaints 28

29 Happenings in other States At least 31 state psychological associations have an active taskforce on prescription privileges. Since 1990, 19 states have presented prescription privilege legislation in their state legislatures In 2002 New Mexico became the first state to pass prescription privileges for psychologists. Several of our neighbors -Tennessee, Arkansas, Ohio, Missouri, Illinois- are actively pursuing legislation 29

30 Happenings in other States CON T. Other states pursuing legislation: Alaska California Florida Montana Connecticut Georgia Hawaii Louisiana Maryland Nebraska Oregon Washington Wisconsin Texas. 30

31 Louisiana On April 15, 2004, the Louisiana House passed prescription privileges for appropriately qualified psychologists On April 21, 2004, the Louisiana Senate voted to grant medical psychologists the right to prescribe medication. The Senate voted 21 to 16; the House voted 62 to 31. Governor Kathleen Babineaux Blanco signed the bill into law on May 6, The law places the oversight clearly under the Louisiana State Board of Examiners of Psychology 31

32 APA Position on Prescription Privileges for Psychologists APA Taskforce Recommendations Other Historical Events 32

33 Other Important Facts ASPPB Position on Prescription Privileges National Examination Malpractice Cost 33

34 In Summary Best Practices in the use of Psychotropic medication improves the quality of life for many individuals with mental health diagnoses There are not enough appropriately trained providers to meet the mental health needs of our communities, especially in terms of appropriate use of psychotropic medications 34

35 Call for Action Upon receipt of the Task force's recommendations, The KPA Board will consider a formal proposal to pursue legislation which would allow Kentucky psychologists to prescribe psychopharmacological agents, contingent on the availability of the recommended monetary and advocacy resources 35

36 QUESTION Who do we want to define our scope of practice? The Kentucky Board of Psychology? or The Kentucky Board of Medicine? 36