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Louisiana finalizes
prescription privileges rule
(May
2005 Issue)
By Elinor Nelson
It's best to be patient when trying to pass prescription privileges
legislation. Legislators need to be educated and prepared to face
powerful psychiatrists' lobbies. The states that have achieved success
took a long-term approach. Following the trailblazing state of New
Mexico, Louisiana last spring became the second state to pass a
law granting prescription privileges to specially trained psychologists.
In January, the state finalized the rules that allow psychologists
to begin prescribing.
According to Jim Quillan, Ph.D., president of the Louisiana Academy
of Medical Psychologists, this law passed on the fourth try over
the course of 10 years. "This law was passed because it serves the
public good," says Quillan. "Like many states, we had a lack of
high caliber psychiatric coverage," with only 500 psychiatrists
statewide. Louisiana has large rural areas, but even in the urban
areas, there are many under served people. However, he'd also like
to see "a more integrated model of care. Medical psychologists [the
new category] are in a position to offer prescriptions and psychotherapy
management and other treatment options . . . Now patients have the
opportunity to get high quality integrated healthcare that will
be more cost effective and safe."
Louisiana's new law has required medical psychologists to hold
a post-doctoral master's degree in clinical psychopharmacology,
with training in anatomy, physiology, neuroanatomy, neuroscience,
biochemistry, clinical medicine, general pharmacology, psychopharmacology
and physical assessment. The program is 500+ hours and takes two
years to complete.
These psychologists must consult with the patient's primary care
or attending physician. Quillan says that 50 Louisiana psychologists
have already earned the master's degree and "a handful" are already
prescribing.
Russ Newman, Ph.D., the American Psychological Association's executive
director for professional practice, agrees that the process is "evolutionary
. . . Over the last five years, there have been 18 different states
with bills pending. We know this will take a long time. We see it
as a good sign that the number of bills continue to grow." Newman
acknowledges that "not everyone" wants to "take that path. It's
one piece of the practice. In time, I think more psychologists will
be interested in pursuing the training."
In New England, Connecticut has had some progress this year. Dan
Abrahamson, Ph.D., the director of professional affairs for the
Connecticut Psychological Association, says the legislation got
a hearing with its public health committee, which "went very well."
The committee authorized a study, "that was a step forward for us."
Abrahamson recalls that four years ago, they had what looked like
a good legislative hearing, "but they were reluctant to touch it
then. This time, they were more familiar with the concept." The
study group will include psychologists and psychiatrists, who Abrahamson
welcomes. "This requires people to sit down and talk about something,
which makes it more difficult to hold onto an adversary stance."
The study is supposed to be completed this calendar year.
The other New England state with current action is New Hampshire.
Sandy Rose, Ph.D., chairperson of the RxP Ad Hoc Committee of the
New Hampshire Psychological Association, says members are "actively
working on a bill we would like to submit next session." Her group
has been active for more than 12 years and she declined to offer
additional details "because of strategy concerns."
She does, however, see access issues in New Hampshire, especially
for children and people on Medicaid, but it is also about "continuity
of care and psychologists using their extensive psychological skills
and medication to help people rely less on medication. It's also
about quality of care."
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