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January 2007, Volume 57, Issue 1

Short Reports

Prescribing privileges for Psychologists among university students in Islamabad

Abstract

Psychologists as part of a team, make important contributions for the treatment of psychiatric disorders. New Mexico and Louisiana in United States have recently granted prescribing privileges to psychologists who have successfully completed additional training. This study determined the opinions of conveniently selected university students in Islamabad on clinical psychologists being granted similar prescribing privileges after additional training and certification by the Pakistan Medical and Dental Council (PMDC).

Four hundred and five students completed the questionnaires; with 51 students enrolled in Psychology departments who were excluded from the reported analysis. One hundred and sixty-five respondents were male (46.6%), and 189 (53.4%) were female. Two hundred and seventy-six (78%) students were enrolled in masters, while the rest in higher degree programme. Cumulatively, 272 (76.8%) students believed that after additional training, clinical psychologists may be allowed to prescribe drugs for the treatment of psychiatric disorders by the PMDC. This viewpoint was reinforced by the act that 264 (74.6%) students replied affirmatively to the question that they would feel comfortable in referring a friend or taking a family member to a clinical psychologist who is trained in prescribing drugs.

Results of our study demonstrated that university students in our study were overwhelmingly in favour of prescribing privileges for psychologists in Pakistan. Professional bodies like PMDC and Pakistan Psychological Association need to broach this subject for greater access to psychiatric services in the country.

Introduction

In medicine, psychiatric disorders form a true nexus between nature and nurture. All psychiatric diseases have psychological components that need to be addressed for their optimal management and treatment requiring more than pharmacotherapy; while physical disorders also tend to manifest patina of psychological morbidity.l-4 Some 450 million people are afflicted with a psychiatric disorder; with profound economic impacts on labour force and national health delivery systems around the world.4 Psychologists do make unique contributions for the treatment of psychiatric disorders, and there is an ongoing debate on enhancing their role by allowing them to prescribe drugs for the treatment of psychiatric disorders.5-6 As an impetus for providing quality care at lower cost while increasing access; the states of New Mexico and Louisiana in United States have granted prescribing privileges to psychologists who have successfully completed additional training and certification requirements.7,8

This study was conducted to determine the opinions of conveniently selected university students in Islamabad on clinical psychologists being granted similar prescribing privileges after additional training by the Pakistan Medical and Dental Council (PMDC), and their acceptance of this new cadre of healthcare providers for the treatment of psychiatric disorders should they need to refer a friend or a family member.

Subjects, Methods and Results

A cross-sectional survey with convenience sampling was conducted among the university students enrolled in masters and higher degree programs in various universities of Islamabad. Three graduate students trained in data collection approached prospective respondents from both natural sciences and humanities departments.

A structured, self-administered, anonymous and pre-tested questionnaire was used with close-ended questions on demographics and opinions about clinical psychologists being allowed to prescribe drugs after additional training by the PMDC, and referring friends or taking family members to such clinical psychologists for the treatment of psychiatric disorders. The questionnaire also contained a paragraph at the top stating that two states in the USA have allowed psychologists to prescribe drugs for treating psychiatric disorders after additional training; to make them aware that such precedent exists. The respondents were explained the objectives of the study and after obtaining verbal consent were invited to complete the questionnaire. Complete confidentiality was assured to all participants while emphasizing voluntary participation in this study. Statistical analysis was done using STATA.9 Responses to questions on PMDC allowing clinical psychologist to prescribe drugs, referring friends and family members for treatment to such psychologists, and pattern among male and female students was compared using Pearson Chi-square test to look for. associations between the dichotomous variables.

From March 7th to May 27th 2005, 460 questionnaires was to conveniently selected students enrolled in various universities in Islamabad. Four hundred and five completed the questionnaires; only 55 students declined to participate in the study owing to time constraints. Hence the response rate was 88%. Fifty one students were enrolled in Psychology departments and were not included in the analysis reported here. One hundred and sixty-five respondents were male (46.6%), and 189 (53.4%) were females. Mean age of students was 22.7 years (range 20 - 40 years). Two hundred and seventy-six (78%) students were enrolled in masters, 61 (17.2%) in M. Phil, and 17 (4.8) were in doctoral programmes. Cumulatively, 272 (76.8%) students believed that after additional training, clinical psychologists should be allowed to prescribe drugs for the treatment of psychiatric disorders, by the PMDC. This viewpoint was reinforced by the fact that 264 (74.6%) students replied affirmatively to the question that they would feel comfortable in referring a friend to a clinical psychologist who is trained in prescribing drugs; 264 (74.6%) students also replied affirmatively to the question that they would feel comfortable in referring and or taking a family member to a clinical psychologist trained in prescribing drugs. However, two male students stated that although they would refer a friend but would not take a family member to such professionals, while two female students stated that they would not refer a friend but would take a family member to such professionals. Table lists opinions and referral preferences of students by gender. No statistically significant differences were observed. using Pearson Chi-square tests for associations between the dichotomous variables studied and gender.

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Conclusion

Competing interests and demands hinder effective long term healthcare planning in developing countries against the backdrop of limited resources. Human capacity development in the healthcare delivery system hamstrung by increasing number of graduating physicians choosing to emigrate from developing countries, calls for innovative solutions to provide better care at an affordable cost to ever increasing populations.9 The evidence on the success or lack thereof, of experimenting with psychologists having prescribing privileges in the United States will take years to be conclusively determined. However, results of our study demonstrated that university students in our study were overwhelmingly in favor of prescribing privileges for psychologists in Pakistan. Interestingly analysis with and without 51 students enrolled in Psychology program lead to similar conclusions, although they comprised of 12.6% of the total respondents. Hence our results were not significantly influenced by respondents who would ostensibly have professional interest in expanding the role of psychologists.

Professional bodies like PMDC and Pakistan Psychological Association need to broach this subject for greater access to psychiatric services in the country. In the end, success or failure of this approach will depend on the acceptance of prescribing psychologists by the individuals and their families who need mental health services. Our results are based on a population that is more educated than is a norm in the country which augurs well for the acceptance of this potentially new healthcare delivery personnel.

References

1. Wiener JM. Integration of nature and nurture: a new paradigm for psychiatry. Am J Psychiatry 2000;157:1193-4.

2. Rutter M. The interplay of nature, nurture, and developmental influences: the challenge ahead for mental health. Arch Gen Psychiatry 2002;59:996-1000.

3. Cooper B. Nature, nurture and mental disorder: old concepts in the new millennium. Br J Psychiatry (Suppl) 2001;40:91-101.

4. World Health Organization. Investing in mental health. Geneva: WHO;2003.

5. Lavoie KL, Fleet RP. Should psychologists be granted prescription privileges? A review of the prescription privilege debate for psychiatrists. Can J Psychiatry 2002;47:443-9.

6. Sechrest L, Coan JA. Preparing psychologists to prescribe. J Clin Psychol 2002;58:649-58.

7. Louisiana grants psychologists prescriptive authority. http://www. apa.org/monitor/may04/louisianarx.html (Accessed on November 14, 2005).

8. New Mexico Senate Approves Psychologist Prescribing Rights. http://www.psychiatrictimes.com/rxbill.html (Accessed on November 14, 2005).

9. Human Capacity Development - The Crisis in Human Resources for Health. http://www.msh.org/what_MSH_does/hcd/ (Accessed on December 25, 2005).

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: