Feb. 28, 2018

Bulgaria: Cardiovascular Primary care

Introduction Cardiovascular risk management by primary care in Bulgaria

Primary care in Bulgaria

In 2000 Bulgaria adopted the general primary care model and initiated reforms in their nation health system. The benefits to Bulgaria of adopting this model were that it included man centered and patient-centered medicine, longtime contact between the GP, their staff, and the patients and their families who have chosen him. In addition, it provides easy and equal access to healthcare and is cost effective for the large volume of medical activity.

In Bulgaria there are group practices, at least 2 general practitioners (GPs), and single practices with 1 GP. All practices are registered as companies following the regulations of the Bulgarian Trade Law. The ambulatory for GP must meet certain criteria appointed by the National Health Insurance Fund as well as additional rules provided by the Ministry of Health to have a contract with the National Health Insurance Fund. GPs are provided with a list of potential patients who have chosen them every 6 months. In addition, GPs are required to hire their staff and nurses; some may be hired as consultants.

The GPs pay all staff salaries and fees, social security taxes, income tax, and practice rent. Many GPs do not have their own offices. GPs buy equipment and consumables and are required to have their bookkeeping done and pay for accordingly. GPs are personally responsible to all institutions directly or indirectly related to their work and are fined in many cases if this is not followed.

In Bulgaria, GPs execute prevention, prophylaxis screening, and vaccination for people of all ages. Additionally, they follow up and treat patients with certain chronic disease, diagnose and cure patients with acute onset of disease, and, in some cases, make home visits. The GPs provide continuous primary care to their patients, including during the out-of-work hours utilizing their own telephone consultations, home visit, or examination in the ambulatory. Some GPs in Bulgaria hire a duty ambulatory, a specially created solely for this purpose. GPs will lead patients through other levels of the healthcare system (e.g., if the health of a patient or other problem cannot be solved in the primary care ambulatory, the GP arranges a referral to a consultant or hospital).

Advantages of primary medical care in Bulgaria

• The specific advantage is that it is 100% Bulgarian. Approximately 50% of our GPs have a recognized specialty in internal medicine or pediatrics and approximately 90% have a specialty in general medicine.

Disadvantages of primary medical care in Bulgaria:

• Often there is unnecessary patient referrals to consultants, specialists, and hospital treatment; this is an underuse of a GPs’ professional qualification and results in raising the cost of medical services. The result is that a significant number of GPs are affected by burnout syndrome. There is a strong tendency for discrediting professional qualifications of doctors who started as GPs during the 2000 healthcare reform. Overall, GPs are limited in their activities as physicians; they are forbidden to treat, or make decisions about the treatment, of asthma and Type I diabetes, and until recently (2009) they were not allowed to treat Type II diabetes and chronic heart failure. Additionally, they were not allowed to refer a patient directly for computer tomographic scanning or MRI without the permission of a consultant and GPs are not allowed to perform conventional echography.
• GPs follow up and treat patients with hypertension, but they are obligated to consult with a cardiologist respective to the patient’s condition every year. Finally, GPs are financially limited in the number of laboratory investigations and other approaches to patient care which, in their opinion, may be useful for patients.

National Association of General Practitioners in Bulgaria (NAGPB)

The National Association of General Practitioners in Bulgaria was founded in 2000. Currently it has 13 members consisting of a president and 12 members, which we are elected for a 4-year term. There are 28 local structures all over the country with a total of 3,800 members accounting for approximately 95% of all the GPs in Bulgaria. There is a yearly national conference and national congress every 4 years. In addition, there are 3 or 4 local conferences a year with many members taking part in international forums, conferences, and congresses. The National Association of General Practitioners are also a part of the Association of General Practitioners and Family Medicine Doctors in southeastern Europe and our members participate in those meetings as well.

Mission of the National Association of General Practitioners in Bulgaria

The mission of the National Association of General Practitioners in Bulgaria is to develop public relations and information exchange, to explain to people what to expect from a specialty that has a wide range and variety of activities, to protect the rights of our patients, professional, economic, and social interests, to respect the principles of medical ethic and deontology, to provide information to our members, and to develop the specialty of general medicine. There is also a large interest in cardiovascular diseases with members actively researching, publishing, and presenting at international meetings including at this year’s EPCCS congress in Dublin. There I presented data from a study using Lipitor in controlling patients with hypertension and Type II diabetes. There are also 3 topics which have been published in the Journal of Hypertension this year; Antihypertensive Therapy in Bulgarian Patients with Diabetes and Hypertension, Comorbidities in Patients with Type II Diabetes and Arterial Hypertension in Bulgarian General Population, and the Risk Profile of Patients with Type II Diabetes and Arterial Hypertension in Bulgarian General Population.