154 Chapter 5 ABSTRAC T Most patients with depressive disorders are treated in primary care, where general practitioners (GPs) may prescribe them pharmacological treatment and/or psychotherapy. The choice between these options, both recommended by guidelines, is influenced by both GP and patient preferences. While lack of access to psychological therapy is often pointed out as a determinant of antidepressant prescription, there is limited empirical evidence to substantiate this claim. We investigated the relationship between psychotherapy supply and GP antidepressant prescription in Portuguese primary care, a country with one of the highest consumptions of these drugs and a very low number of psychologists working in the national health service. We used panel data on all GPs in Portugal between 2015 and 2018 and a within-between random effects model to investigate the effects of changing numbers of psychologists in GPs´ prescription over time (within variation). Additionally, we explored the association of prescription patterns with between GPs variation in the number of psychologists. We found heterogeneous effects of increasing one psychologist/100,000 patients on GPs´ prescription share overtime. While there was no average effect, the subgroup analysis of GPs exposed to the lowest and highest quartiles of average number of psychologists showed that increasing one psychologist/100,000 patients overtime led to a reduction of 2.9% and 4.4% in the prescription share, respectively. Findings for the between term showed that GPs facing a one-unit higher average number of psychologists/100,000 patients have a lower prescription share, by 3.6%. Our results suggest that in the context of scarce resources, small increases in the number of psychologists might not lead to a reduction of antidepressant prescription across all levels of supply. Furthermore, policy action should consider the range of unmeasured characteristics and processes behind the fact that GPs with lower antidepressant prescription are working in settings with higher average supply of psychological therapy.
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