Slovakia: Cardiovascular Primary care overview

During the first EPCCS Council meeting in December 2017 brief introductions were provided on the current organization of cardiovascular risk management in primary care in different countries. This section aims to provide an impression of the current sitiuation in Slovakia. In Slovakia, we have the Slovak Society of General Practice. It was established in 1979 and has almost 1,400 members. We are full member of WONCA. Education is the key role of Slovak Society of GP. Education focused on conference of regional training, conferences abroad. We are part of EQUIP, European Forum of Primary Care, and WONCA. Our big success is annual conference, which is held every year, same place, and same time in October

Slovakia

The GP society in Slovakia is the Slovak Society of General Practice. It was established in 1979 and has almost 1,400 members. We are full member of WONCA. Education is the key role of Slovak Society of GP. Education focused on conference of regional training, conferences abroad. We are part of EQUIP, European Forum of Primary Care, and WONCA. Our big success is annual conference, which is held every year, same place, and same time in October .

Recommendations in Slovakia

Recommendations, specifically for Slovak GPs, include the prevention of stroke by patients with atrial fibrillation and screening of atrial fibrillation. We also adopted the guidelines, including EPCC and Diagnostical procedure and management of patients with chronic heart failure in primary care. We promoted these 2 guidelines in an annual conference and the next year, we did regional training. Almost 10 regional trainings over Slovakia. We called to the Slovakia and tried to adopt these guidelines for GPs. For example, screening for atrial fibrillation, how to find atrial fibrillation, check the pulse whenever we have possibility at our office. Assist according to CHADS-VASC and immediately when the patient is well conditioned, start anticoagulation therapy. It is necessary to say that in GP, they can start with warfarin, because the new novel anticoagulants are not allowed to be prescribed by GP. We participate for pre- and post-graduate training on the medical faculties as external teacher and member of our society. We have 4 medical faculties in Slovakia, 2 of them are situated in Slovakia. We also have good cooperation with the Slovak Patient Organization and this is important for preventative programs.

*Primary Care in Slovakia*

Primary care in Slovakia includes the use of general medicine for adults. This is GP and general care of children and adolescents, pediatrician. About 90% of GPs are self-employed, they own their private practice and 10% are employees in private centers. We own 1 financial group in Slovakia. GPs provide mandatory 24-hours, 7-day healthcare. How many patients are in the registry of GP? This is the problem, because 1 GP cares about 2,000 patients. In the rural region, the number is higher. The average number of patients per day can be between 50 to 60. Why? It is lack of GPs, especially in the rural regions. Average annual number of visits to GP, due to OECD, it is almost twice. Why? Due to legislative ban, it is the same situation as in Bulgaria. We are not allowed to prescribe many drugs to treat common conditions and we need to refer the patients to the specialists. For example, 1 day, a patient needs to visit 2 doctors because patient needs a recommendation. GPs prepare recommendations and refer patients to the specialists, and then specialists write the medicine on prescription and the GPs come back again to the doctor. Everything is due to legislative ban and we have struggled since 2004 with them. Our patients and doctors are lost in the labyrinth.

Health Insurance in Slovakia

We have free health insurance companies, 1 is public and 2 are private. Mandatory for health insurance company is a signed contract with the GP. We also have a capitation fee. This is 80% per capita and 20% fee for service. That is the fundamental problem, because the average capitation fee is not more than 2.8 Euro per patient, per month. Fee for service, including preventive examination every 2 years we can do that, ECG we can do, and the health insurance pays more if the patient is acute. Arterial hypertension that is paradox, because we can treat when we find patients with arterial hypertension and the health insurance companies pay for that. It is the result that gatekeeping role of GP and it is not okay. We have residential program for graduated GPs of 5 years. It is 5 years and now we have 100 resident doctors.

Cardiovascular Disease & Primary care

Interest in CVD. As mentioned, atrial fibrillation, chronic heart failure, and well controlled anticoagulation therapy. Well controlled atrial hypertension, and reduce overweight obesity, which is a problem in Slovakia now because overweight is increasing and we know that it is a risk factor of atrial fibrillation. We do ankle/brachial index in patients with risk factors and good compliance. It is good to treat the patient when we have good relationship with them. Now, we have worked on a new project, the Slovak Patient Organization, screening of atrial fibrillation is in our hands. Prevention is better than cure and we will promote this project.

Education/Congress in Slovakia

The 24th European WONCA Conference will be held in Bratislava. Next year we have opportunity to do EQUIP conference, first time again in Bratislava. GP Cornerstone for Healthcare of High Quality, which will be in March in Bratislava.