171 Antidepressant therapy prescription, do psychologists help? Evidence from Portugal shows that younger GPs were more likely to substitute antidepressant prescriptions with psychotherapy when the supply of psychologists increased overtime. Interestingly, the between terms are also smaller and less precise for female GPs, the eldest GPs, and GPs operating in cities and rural areas, compared to the main model. This suggests that the prescription behaviour of these groups might be less likely to be associated with unmeasured characteristics and processes driving the association between a higher number of psychologists and lower prescription. When we stratified GPs by their average prescription rate, the results were mostly non statistically significant (Table 4). Nevertheless, we noted two interesting patterns. First, we observed that GPs with the highest average prescription rate were more responsive to an increase in psychologists over time (3rd and 4th quartiles). Additionally, the between terms were smaller – or even positive – and non-statistically significant, suggesting that grouping GPs by their prescription share might take away some differences in unmeasured variables driving the previously observed association. Table 4. Heterogeneity in the association of psychological therapy supply and antidepressants prescription rate by average antidepressant prescription rate of GPs. Average GP antidepressant prescription rate Main specification 1st Quartile (lowest) (1) 2nd Quartile (2) 3rd Quartile (3) 4th Quartile (4) (5) Psychologists/100,000 patients Within-term 0.0808 -0.0677 -0.622 -0.464 -0.305 [-0.0835,0.245] [-0.563,0.427] [-1.277,0.0333] [-1.516,0.589] [-0.706, 0.0954] Between-term -0.0896 -0.193** -0.0608 0.489 -0.955** [-0.385,0.206] [-0.335,-0.0506] [-0.226,0.104] [-0.303,1.280] [-1.641, -0.269] Year dummies Yes Yes Yes Yes Yes GP, GP practice and Local group* covariates Yes Yes Yes Yes Yes Yes Yes Constant 18.62 13.17 39.00*** -5.108 [-5.275,42.51] [-4.464,30.80] [21.48,56.51] [-77.27,67.06] 22.45 N 4305 4300 4305 4300 [-48.56,93.46] N Clusters 55 55 55 55 17,210 R2 within model 0.0562 0.102 0.102 0.126 0.0756 Mean dep. variable Min-max average psychologists Notes: The dependent variable is the share of adults with depression in the GP list that has been prescribed antidepressants. Covariates are included in the model demeaned and centered (e.g. for each covariate two terms are included, one with the mean over the study period and other with the difference from the mean in each year). *Some of the covariates are reported at the municipality level, which corresponds roughly to the local group geographical boundaries. 95% confidence intervals in brackets. Standard errors clustered at the local group level (55 local groups in all models). * p < 0.05, ** p < 0.01, *** p < 0.001 5
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