159 Antidepressant therapy prescription, do psychologists help? Evidence from Portugal During our study period, patients paid a small fee for primary care appointments, which ranged between 4.5 and 5 euros per GP consultation and 3.5 euros per psychologist appointment2. Several groups were exempted from this co-payment, including poor patients and pregnant women [47]. Most patients would also need to co-pay for their antidepressants. While the exact amount paid out of pocket varied over time and with the drug used, brand/generic choice, dosage and pack size, the monthly co-payment of antidepressant medicines would usually not exceed a few euros.3 METHODS Data We used data from three nationwide sources. First, the administrative database SDM@SNS (Sistema de Dados Mestre do Serviço Nacional de Saúde), from the Central Administration of the Health System (Administração Central do Sistema de Saúde IP; ACSS), which contains data on a vast set of indicators monitoring all primary care providers. Second, the human resources register RHV (Recursos Humanos e Vencimentos), which contains information on the primary care workforce, including GPs and psychologists. Third, municipality-level characteristics were obtained from the Portuguese national statistics bureau (Instituto Nacional de Estatística - INE) and Eurostat. The first and second sources were linked at the GP level, while the third source was linked at the GP practice level, based on the practice location. Study Population Our study population consists of an unbalanced panel of the universe of GPs in the Portuguese NHS over 4 years (n= 5,359, 2015 to 2018). The study population includes full-time GPs working at least 12 months in a GP practice during the study period. The small number of GPs that switched practices between different local groups were excluded (3.8%), as well as observations from GP practices that underwent migration of the information software during the study period (0.4%); and observations of GPs with patient lists smaller than the first percentile of the list size distribution (1.9%; likely data coding issues or exceptional situations occurring in practice transition periods). Last, we excluded observations with missing values in the variables of interest for our main models 2 Price of mental health services available at the Central Administration of the Health System (ACSS) website in https://www.acss.min-saude.pt/2016/10/03/tabelas-meios-complementares-de-diagnostico-e-terapeutica/ (visited in January 2023). Primary care visits copayments were extinguished in 2020. 3 Taking sertraline 50 mg and the year of 2023 as an example we observe the out of pocket cost for packages with 60 pills ranges between 1,99 and 7,43 euros for the generic drugs, and 12,05 euros for the brand drug. Given that sertraline has a daily defined dosage (DDD) of 50 mg the monthly cost of treatment could then go from 1 to 6 euros. Information about prices is made available by the national drug authority Infarmed: https://app10.infarmed. pt/genericos/genericos_II/lista_genericos.php?tabela=spr&fonte=dci&escolha_dci=U2VydHJhbGluYQ==(visited in April 2023). 5
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