Do Bulgarian patients with cardiovascular diseases collide access limitations to primary healthcare services during lockdown in Bulgaria?

Nevena Ivanova

Keywords: primary care, GP, cardiovascular, access


SARS‐CoV‐2 virus emerged in China in 2019 and became pandemic in March 2020. This led to enormous burden of healthcare systems and medical stuff. Countries struggled the surge of patients and faced unpredicted organizational problems.

Research questions:

Are there access limitations to primary care during COVID-19 lockdown in Bulgaria, 03-04.2021


A pilot study of 50 patients and 10 individual GP practices was conducted. A special questionnaire was developed


34 of patients were male (68%), 26 (32%) female, divided into 4 age groups 18-30 years (1 or 2%), 30-50 (5 or 10%), 50-70 (18 or 36%), 70 and older (26 or 52%). Patients suffered one or more cardiovascular disease-6 (12%) had one, 26 (52%) had 2, 13 (26%) had 3, 5 (10%) had 4. 48 patients suffered hypertension, 3 survived myocardial infarction, 8 had permanent atrial fibrillation, 18 chronic heart failure. 26 people (52%) sought consultation with GP due to severe COVID-19 symptoms, 1 (2%) for regular chronic disease monitoring, 5 (11%) for drug prescription, 48 (36%) due to poor chronic cardiovascular disease control and related complaints. 26 patients (52%) reported difficulties and access limitation to their GP. 1patient (2%) couldn’t reach the GP by the phone, 3 (6%) couldn’t access the hospital where the practice was located, 9 (18%) were not allowed by the GP to enter practice room, in 13 (26%) GP refused examination. In that group 9 patients (69%) complained severe COVID-19 symptoms and 4(31%) had other complains. 7 of 10 practices were in Plovdiv city, 3 were rural.


The majority of patients were older than 70 years and suffered 2 or more cardiovascular diseases. 52% of all patients experienced access limitations to GP. The main reason for examination denial were COVID-19 like symptoms.Changes in organization are needed to improve access to medical services especially for patients with cardiovascular diseases

Points for discussion:

how to improve access to primary health care services