Adding a practitioner with prescriptive authority to your therapy practice can help expand your practice and improve your quality of patient care. Patients have been shown to benefit from the combination of psychotherapy and medication for disorders such as depression. They are much more likely to realize this benefit if your practice fulfills both needs.
This article offers insights and strategies for behavioral health professionals looking to incorporate prescribers into their practices.
Understanding the Role of a Prescriber
In a behavioral health practice, a prescriber is a practitioner who is qualified to prescribe medication. Depending on state or local laws, this group may include psychiatrists, mental health nurse practitioners, primary care physicians, family nurse practitioners, and psychiatric pharmacists.
All such practitioners receive lengthy and intensive training on the benefits, risks, and appropriateness of psychiatric medication. Depending on local laws, those with less training, such as nurse practitioners, may be required to be supervised by a physician, such as a psychiatrist.
Medication can be effective for many mental health disorders, such as depression. Research indicates that British patients found mental health nurse prescribers to be easier to talk with and trust, which increased medication adherence and efficacy of treatment (Ross, 2015).
Expanding Services and Access to Improve Quality of Patient Care
Having a prescriber on staff expands the range of services offered by your behavioral health practice. Your patients will benefit from integrated therapy and medication management, resulting in improved medication adherence, increased patient satisfaction, and better treatment outcomes.
This can also be a differentiating factor for acquiring new patients and increasing the number of clients a full-time therapist can see in a week. With a prescriber on staff, you will be able to closely monitor patients’ medications and adjust treatment as needed, without having to refer patients to an outside provider. This improves access to care, quality of patient care, and aligns with nearly 50 years of research supporting the efficacy of combining therapy with medication (Mintz, 2006).
Jabbal (2010) writes about a 17-year-old patient – as an example of how having a prescriber can help – who developed hypersalivation after several months on clozapine. Although this is a common side effect, it threatened to derail a treatment breakthrough. Following several unsuccessful attempts with other drugs, clozapine was the only drug that managed to stabilize the patient’s condition.
But, due to the side effect, the patient was contemplating discontinuing the medication. Although this practice had a psychiatrist, he or she was unfortunately on vacation at this time. However, the patient’s mother advocated strongly for her son and remembered that he was being treated by an interdisciplinary team, including a clinic pharmacist.
Working together, they were able to quickly prescribe sublingual eye drops that alleviated the side effect and prevented a potential setback.
Collaborative Care Model
The collaborative care model involves an interdisciplinary team, not unlike the success story highlighted in the prior example. This can be a game changer in behavioral health. When therapists and prescribers work together, they can provide high-quality, comprehensive behavioral healthcare. The result is more effective treatment than if they were working separately or alone.
In the collaborative care model, a behavioral healthcare manager, which may be a psychologist or other practitioner, works in concert with a referring primary care physician and a psychiatrist or psychiatric consultant. Together, they provide evidence-based psychotherapy in concert with medication, or a determination that medication is not recommended.
Recent research (e.g., Reist et al., 2022) has supported the collaborative care model in the treatment of postpartum depression and substance abuse disorders. It is expected that this body of evidence will continue to grow.
Legal and Regulatory Considerations
There are many legal and regulatory aspects of incorporating a prescriber in your practice, and these vary widely between U.S. states. As a non-prescribing practitioner, you may be required to be supervised by a prescriber, and the requirements of these supervisory protocols may vary from state to state.
Licensing requirements and scope of practice vary. Depending on your jurisdiction, you may be able to prescribe with the help of a consulting prescriber (e.g., as an independent contractor). In other cases, you may be required to have a prescriber on-staff, or you may even be able to become a prescriber yourself!
In June 2023, the American Psychological Association wrote about new momentum for psychologists to be prescribers. This is now possible in Guam, New Mexico, Louisiana, Colorado, and several other states.
In Florida, a nurse named Barbara Lumpkin advocated for expanded prescriptive authority for over 20 years, culminating in the Barbara Lumpkin Prescribing Act of 2016, which allows nurse practitioners to become certified to prescribe controlled substances including ADHD medications.
With the recent COVID-19 pandemic, mental health access and care in the United States has become a more pressing issue, so prescriptive authority is expected to expand.
In all cases, consulting with state licensing boards, as well as colleagues in private practices and professional organizations, are recommended as first steps toward adding a prescriber to your practice.
The Hiring Process
Investigate the above avenues, and you will know whether you need to hire a psychiatrist or other prescriber as an employee, or work with one as an independent contractor. If your practice is best served by hiring an employee, you will want to advertise for candidates and ensure they have valid credentials and strong references.
Make sure to clearly define their role, considering your practice’s needs and budget. Do they need to be full-time, or would part-time be sufficient? How will you work as part of a collaborative practice? What type of prescriber would align with your practice’s values and goals?
Lastly, don’t forget to solicit advice from professional mentors and colleagues. Such advice may be more valuable than anything you can find online.
Integration with Electronic Health Records (EHR)
Integrating prescriber documentation within an EHR system is vitally important. A good EHR supports seamless collaboration and information sharing. For example, a strong EHR will:
- Electronically send prescriptions to pharmacies
- Keep accurate records
- Cross-check with other prescriptions for potential allergies and contraindications
- Automatically check the federal prescription drug monitoring program (PDMP) database
- Integrate with an e-prescribing service such as DrFirst.
This can make your new prescriber’s job much easier while enhancing patient care and revenues.
Conclusion
A behavioral health practice with prescriptive authority has more tools at its disposal to effectively monitor and treat patients. This can help increase quality of patient care and increase patient volume and satisfaction.
Here, we have discussed these benefits. In addition, we covered hiring or contracting with a prescriber, or possibly becoming a prescriber yourself. More and more states are recognizing the need for expanded access to behavioral healthcare, including medications, so it is important to monitor new laws and developments in this space.
Look closely at adding a prescriber and an effective EHR software to your behavioral health practice. These are two highly impactful ways to expand and enhance your business.
References / Sources:
https://evidence.nihr.ac.uk/alert/combined-drug-and-psychological-therapies-may-be-most-effective-for-depression/
https://www.nami.org/About-Mental-Illness/Treatments/Types-of-Mental-Health-Professionals
https://pubmed.ncbi.nlm.nih.gov/26031457/
https://www.psychiatrictimes.com/view/combining-drug-therapy-and-psychotherapy-depression
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809439/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803502/
https://www.apa.org/monitor/2023/06/prescriptive-authority-psychologists
https://www.orlandosentinel.com/2016/05/13/barbara-lumpkin-the-woman-behind-a-new-prescribing-bill/
