To urgently ease the administrative procedures for patients with chronic diseases in the country through the introduction of phased electronification in health care and ensuring integrated social and health care in the home environment – this was the consensus of participants in a discussion organized by the National Patients’ Organization (NGO), which presented the progress of the COVID Alliance initiative.

The NGO’s project, in conjunction with professional bodies, leading medical societies, patients, the pharmaceutical industry, the IT sector and others, aims to propose regulatory, socio-health and digital solutions to reduce the impact of COVID-19 on the country and the healthcare system.

The medical professionals present at the discussion supported the proposed measures, especially the avoidance of unnecessary visits to health facilities.

“Remote consultations for diabetic patients in stable condition are quite possible and feasible”, commented Prof. Tsvetalina Tankova from the Bulgarian Scientific Society of Endocrinology. “We can drastically relieve patients in stable condition, for whom an appointment with the doctor is not necessary, when this can happen remotely,” added prof. Tankova. She gave examples of diabetic children who see endocrinologists monthly, as well as patients who need more assistance in the home environment than in the medical facility. “Patients who are seen by their doctor, stay in stable condition, and are under observation can be counseled remotely. For them, frequent on-site follow-up is not necessary,” Prof. Kosta Kostov from INSPIRO Foundation, consultant of St. Anne’s University Hospital.

“Many of my patients have chronic illnesses. If they can electronically send me spirometry, lab tests, X-ray, there is no problem to be consulted remotely,” the professor said.

“The Bulgarian Medical Association has always supported the development and digital possibilities to reduce the burden on doctors and patients,” declared Dr. Gergana Nikolova, member of the Board of the Medical Association. “We support electronic prescriptions, referrals, the creation of an electronic register of protocols to replace paper copies. We have advocated for protocols to have a longer term for patients with chronic diseases, our initiative was for protocols to have a one-year term. However, the relationship with the patient should not be lost, and innovations should be introduced slowly so that they can be applied by everyone,” Dr Nikolova recommended.

“At least three steps of patients with chronic diseases who receive medicines every month can be saved immediately if GPs and specialists in outpatient care use the state’s secure electronic delivery system, in which most GPs are registered.” According to him, the protocols can be sent through this system to the Regional Health Insurance Fund or the National Health Insurance Fund, and the Fund in turn finalizes them and sends them electronically to the doctor. On this basis, the medic will be able to issue a prescription to the patient. Pharmacists would be able to check the protocols through the existing system of the Treasury and the patient record. “The introduction of e-prescription will stop duplication of the same information in different cuttings and forms, as well as in the prescription booklet,” Dr Sotirov added.

As part of the project, the National Patients’ Organisation is preparing a platform to integrate digital services for doctors and patients to support healthcare until the unified state health information system is in place. Through these, patients will be able to use different services and doctors will choose which solution is right for them. The first prototype of this portal could be shown in two weeks, assured the Bulgarian Cluster for Digital Solutions and Innovations in Healthcare, a technology partner of the NGO.

Integrated social and health services are very important for people with chronic diseases, especially those in small settlements, and digital health solutions suitable for them can be implemented with the assistance of social workers and specialists. From September this year, the Bulgarian Red Cross will monitor 500 elderly patients in Vratsa and the region, including a call centre and special software that monitors their basic vital signs. “In the COVID environment, the Bulgarian Red Cross home care centres were the patients’ only link to their doctors and pharmacies,” Dr Nadezhda Todorovska, Deputy Director General of the Red Cross, said during the discussion.

0800 14 515 – information line for patients with chronic diseases

For the period from 22 April to 27 May 2020, the information line of the National Patients’ Organisation dedicated to patients with chronic diseases – 0800 14 515 – received 2,630 calls. The line is a donation from VIVACOM and Call Flow and will be active until the end of June 2020. On it, every working day, from 9 am to 6 pm, endocrinologists, oncologists, cardiologists, psychologists and infectious disease specialists provide consultations to patients with various diseases. Data show that one in three callers seeks the help of a cardiologist and one in four seeks the help of an endocrinologist. One in 10 patients needs psychological support.

According to the analysis, the calls were not related to COVID or the anti-epidemic measures, but referred to systemic problems dating back to before the state of emergency It can be concluded that patients need more information and time with their doctors to discuss their condition and therapy. Thanks to the helpline, emergency medical care was provided for 6 patients, the analysis further shows. 12 patients were assisted to receive their prescribed medication, which is not available in Bulgaria. Many of the patients who call the psychologist are single people or young people who are unemployed, as well as patients with anxiety and depressive states as a result of their isolation and socio-economic situation. Five declared that they were victims of violence.

The team of the National Patients’ Organisation followed up all elderly patients living alone who had sought advice by telephone. 0800 14 515. Thanks to this, 37 patients without relatives were assisted to receive hot meals and care at home by the municipalities where they live. Helmets, masks and disinfectants have been provided to the personal assistants of 9 hard of hearing people who have stopped visiting the patients’ home for fear of contracting COVID. 43 patients were provided with information on how to use their social and health rights and 4 single parents were provided with food and essentials.

Partners in the COVID Alliance initiative:

Bulgarian Medical Association

Bulgarian Pharmaceutical Union

National Association of General Practitioners

Bulgarian Red Cross

Bulgarian Association of Health Care Professionals

World Health Organization Office in Bulgaria

Association of Research Pharmaceutical Manufacturers in Bulgaria – ARPharM

Bulgarian Generic Pharmaceutical Association -BGPharmA

Bulgarian Pharmaceutical Wholesalers Association – BAPW

Bulgarian Cluster for Digital Solutions and Innovation in Healthcare

Bulgarian Organisation for Verification of Medicines

Bulgarian Association for the Development of Parallel Trade in Medicines

Bulgarian Business Leaders Forum

Sofia Municipality

Bulgarian Society of Endocrinology

Bulgarian Society of Pulmonary Diseases

Society of Cardiologists in Bulgaria