Little is known about how barriers to research participation are perceived, affected by or interact with patient characteristics, or how they vary over the course of a clinical trial. Participants (285) in the Renin-Angiotensin System Study (RASS), a randomized clinical primary prevention study of diabetic nephropathy and retinopathy at 2 Canadiana dn 1 US university, rated potential barriers to research participation yearly for 5 years. Baseline barriers rated as most adversely affecting participation were: missing work; frequency of appointments and procedures; study length; number of appointments and procedures; access to study location; and physical discomfort associated with procedures. Inadequate social support, unstable job, and use of alcohol and drugs were cited relatively infrequently, suggesting that although they may be important, candidates for whom these might be issues likely self-selected out of the study. Gender and gender by age interactions were found for specific perceived barriers, such as work and child care, and baseline barriers correlated with adherence. Elucidating the natural history of barriers to research participation is a step toward identifying strategies for helping participants overcome them, and ultimately may enhance the conduct of research.

Although many psychologists support prescription privileges, the historical training paradigm in psychology includes limited scientific education directly relevant to prescribing medications. Issues related to prescriptive authority for psychologists, including training gaps, attitudes, accreditation, and regulation, are discussed. Current proposals for training psychologists to prescribe deleted the prerequisite coursework in the biological and physical sciences that had been identified by the American Psychological Association's Ad Hoc Task Force on Psychopharmacology. Current proposals do not delineate clear requirements for several key aspects of supervised practical training. Such training limitations raise basic questions about how much additional scientific and medical training would be necessary to ensure that psychologists could provide an acceptable quality of clinical pharmacologic care.

No abstract