 |
The Added Value of RxP Training |
|||||||||||||||||
|
Professional Practice |
John L. Caccavale, Ph.D., M.S. Clinical Psychopharmacology |
|||||||||||||||||
 |
|
|||||||||||||||||
|
The true added value of psychopharmacology training (RxP) may be difficult to ascertain at this time because training is relatively new and the number of psychologists who have completed level II training are relatively few. Perhaps, four to five hundred, at best. Nevertheless, the experiences of individual psychologists can provide a sort of template showing trends that no doubt will be shared among those who will complete RxP training and integrate psychopharmacology into their practices. From personal experience and those of psychologists similarly trained, I have concluded that RxP training can be the single most factor to benefit both practitioners, patients and psychology. I have delineated several key areas where I personally have experienced the added value of RxP training: Increased Patient Safety; Enhanced Patient Services; Professional Growth & Recognition; Enhanced Practice Revenues; and Reduced Treatment Costs. There are other factors beyond these that can also be attributed to RxP training, such as the impact of training on mental health policy. However, I’ll leave that for another time. Increased Patient Safety I am a partner in an injury practice and I integrated psychopharmacology into my practice in 1995. All of my psychology partners are trained in psychopharmacology. The physicians and other medical specialties that we deal with generally have no further training in psychopharmacology beyond medical school and residency. Typically, the patients I see have at least three other specialties providing treatment. Many times there may be in excess of seven providers. Invariably, all these specialties prescribe one or more medications and rarely know what the others have prescribed. Generally, my patients have no idea of even why they were prescribed any one medication let alone several. Because of my RxP training and because I am the one specialty who actually sees the patient on a regular basis, I am in the unique position of being able to evaluate the drug-drug interactions and the medication errors of the many medications being prescribed for an individual patient. It is the norm that I find potential and real harmful side effects due to interactions. Medication errors are frequent. I am able to communicate this information to the patients and to the other specialties. I am able to recommend which medications should be discontinued or changed. The majority of times physicians ask me to monitor and manage the medication regimen. Without RxP training both my patients and myself would be at a terrible disadvantage. RxP training has helped me to become a far better practitioner. I am sure that this experience extends to many others who have completed psychopharmacology training. Enhanced Patient Services Because I now integrate psychopharmacology factors into my evaluations, I am able to provide a needed and valuable service to my patients. My evaluations are more complete. I provide every patient who is taking a medication with a simple statement showing the interactions and side effects of their medication regimen. I have found that few patients read or understand the literature given to them by pharmacists. I am a fluent Spanish speaker and over 85% of my patients are Spanish speaking, I provide them with important health information that they have difficulty getting elsewhere. I can say that many of these patients are prescribed medications without the benefit of anyone being able to communicate with them. I have seen janitors “translating” for physicians. In the world of English speaking practitioners anyone who can read a menu can be a translator. While all patients benefit from psychopharmacology training, under served populations greatly benefit from having a psychologist trained in psychopharmacology. There are many other examples that I can cite with respect to increased patient services but for now these should suffice. Professional Growth & Recognition Anytime a professional can obtain an added proficiency, professional growth is enhanced. However, with RxP training there is the added value of being recognized by both peers and other specialties, particularly physicians. Medications is the currency of communication with the medical profession. When a non-physician can communicate using this currency the artificial line separating the two becomes much smaller. In some cases it even disappears. On a daily basis, I am called upon by physicians to evaluate and recommend psychotropic medications. After a contact, I always follow up with a simple report, many times only one page, showing the particulars of the medication discussed. I have been requested by physicians to recommend medications to their family members. Clearly, these physicians have access to psychiatrists but my experience is that non-psychiatric physicians prefer to speak and deal with a psychologist trained in psychopharmacology. This is the type of recognition that we will need to realize our national RxP goal. Besides the recognition obtained from medical practitioners, psychologists trained in psychopharmacology can expect being consulted by other colleagues and new referrals from existing patients. This is particularly true in areas lacking a diversity of other specialties. RxP training has also given me the opportunity to speak and write on subjects from a different perspective. All of these have contributed to both my personal and professional growth. My discussions with other RxP trained psychologists indicates that all have enjoyed what I am experiencing. Enhanced Practice Revenues From an economic perspective, I have long ago recovered my investment in RxP training. I calculate that my RxP training accounts for an additional 35% of my overall revenues on a yearly basis. I base this on increased referrals, additional charges for medication recommendations, increased fees for my forensic evaluations, increased visits for patients on medications, and the development of novel services, e.g., performing medication case reviews for insurance companies of patients that they suspect are not getting the right medications. With RxP training one can expect seeing increased revenues from the above sources as well as any number of other areas depending upon geographical location, type of practice and other training. However, no matter how one looks at the issue, RxP training will allow one to recoup their investment. I know that there are some critics who believe that this is the main thrust for prescriptive authority. The fact that we can recoup our investment is great. There should be no shame in earning a good honest living. The fact that RxP also pays is just another added value. Reduced Treatment Costs Overall treatment costs, whether paid by an insurance carrier, employer or individual, can be significantly reduced when a psychologists is trained in psychopharmacology. RxP training greatly reduces overall office visits to physicians because the patient gets diagnosed appropriately and quicker. They get an appropriate recommendation for medications, when necessary. Many studies have already demonstrated that it can take a significant amount of time for general practitioners to correctly diagnose and subsequently appropriately treat patients with depression and anxiety. The costs associated with this no doubt are significant. If one were to factor all the costs, including the impact on the national economy from absenteeism and other down time, we could probably fund and extend full health insurance coverage to the uncovered from these savings. RxP training has the potential to significantly reduce the costs associated with bad diagnoses and adverse drug events associated with medication errors, which is estimated by the FDA to be in the range of 72 billion to 120 billion dollars annually. RxP training can significantly reduce costs associated with symptoms resulting from side effects from polypharmacy and inappropriate medication regimens. RxP training can significantly reduce overall costs for mental health because those so trained know when medications are appropriate. For the year ending 2001, the combined costs for all medications in the United States exceeded 132 billion dollars. RxP trained psychologists can significantly reduce this expenditure because experience shows that we tend to recommend reducing or discontinuing overall use of psychotropic medications. In practice, this can also equate to better efficiency and effectiveness. Its a “win-win” situation. In conclusion, from whatever perspective one looks at the issue, RxP training presents a lot of added value to any psychologist choosing to make the relatively small sacrifice associated with training. The gains to patients, practitioners, psychology, and society as a whole, can be significant. Although I have addressed only a few of the issues associated with the value of RxP training, I am sure that many more will surface as we proceed to enter into an area that is the proper domain of psychology. The public interest is served with RxP and I strongly recommend and advocate to all psychologists that they take the time to investigate the many programs now available to become trained and gain a proficiency in an area vital to our patients and profession References Reducing and Preventing Adverse Drug Events to Decrease Hospital Costs. Research in Action. Issue Number 1. Agency for Health Care Policy and Research, Rockville, MD. Center for Research Dissemination and Liaison. Testimony on Medical Errors: Understanding Adverse Drug Events by Janet Woodcock Director, Center for Drug Evaluation and Research, Food and Drug Administration U.S. Department of Health and Human Services. Before the Senate Committee on Health, Education, Labor, and Pensions. February 1, 2000. Health Financing and Public Health Issues U.S. General Accounting Office February 1, 2000 |
|||||||||||||||||