Romania: 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, by de Dr Mihaela Daniela Balta

Primary care in Romania

In Romania there are approximately 49,000 physicians, and about 1/4 are family doctors. All are members of the Romanian College of Physicians, which is a non-governmental national medical association. Only 6% are simply GPs, no specialization, however 1/2 are senior family doctors with 5 years in family medical specialty.

Family doctors work about 61% in urban areas and 39% in the rural areas. The terms of practice are negotiated and contracted between the family physicians and the National Insurance Health House every year. GPs are paid by the National Insurance Health House. The National Health Insurance House was established in 1999. It is a public institution, autonomous, of national interest, with legal personality, whose main activity is to ensure consistent and coordinated operation health insurance systems in Romania. It ensures, supervises, and contracts the social health insurance system. It settles a comprehensive providing healthcare system for all citizens.

There are 2 categories of packets, basic for insured person, and minimal for non-insured people, like only for emergencies.

The family doctor is the first contact of the patient. Each family doctor has on average between 1,200 and 1,800 patients. It is recommended that we have below 2,200 patients. Most of the family doctors are independent managers with some working in a partnership or in group practices, however, the groups share auxiliary staff and facility, not the patients list. The family doctor manages the cabinet, must employ at least 1 nurse, and has relations with the authorities. They can also employ and can perform certain competencies like ultrasound, electrocardiogram.

Health is delivered either by consultation at the physician practice or by home visits, including child, maternal care, vaccination of children, health examination, and prescription of appropriate drugs. But we need the specialist’s approval for them, not for cardiology. The family physician is responsible for referral of the patient further in the system for investigation or to a medical specialist or to the hospital system.

Romanian National Society of Family Doctors

The Romanian National Society of Family Doctors is the main professional association of family doctors in Romania. It was founded in 1990 and currently has 41 local organizations, 1 from each county. The main activity is improving family doctors’ education, improving medical practice, updating legislation, and negotiation with the National Health Insurance House. It has been a WONCA Europe member since 1994 and it has a representative in WONCA council, EURACT, EURIPA, and Vasco De Gama Movement. We have national congress every 4 years, the last one was in 2016. We have also 2 national conferences every year, 8 regional conferences every year, workshop, monthly symposiums, summer school, and courses for doctors. Our society elaborated 10 guidelines made by GPs from the National Center for Family Medicine Studies, the last 1 was a prevention guide which was elaborated in 2016. It is an adaptation under European guidelines. We have also e-learning portal courses for continuous professional development.

Our organization has 12 working groups. We have also a cardiology working group founded in 2015, eight members. You can see seven of us. We attend congresses and conferences of family doctors but also of cardiologists in Romania. We take presentation at the congress. We have workshops and courses for family doctors. We have a close collaboration with the Cardiologists’ Society in Romania. We are in partnership with them in developing a cardiovascular disease prevention program in our country.

Romania has 12 university family medicine departments in which about 30 family doctors work. Family medicine is taught in the 6th year at university. In many university centers, professors and assistant professors are family doctors, but not in all. We have also cardiologist professors in some of them. In 1991, family medicine became a clinical specialty with 3 years GP residency program. Beginning in 2017, family medicine residency now lasts 4 years. The doctors are practicing in hospital and in the family doctors’ offices. We have a total authorized number of 228 GP trainers. The national entry exam into specialized training is the same for all specialties. Practical and theoretical exams at the end of training to receive full license to practice. Afterwards, each doctor must do 40 continuous professional development points every year to renew his license to practice.

Cardiovascular disease in Romania

Romania is 3rd concerning prevalence rate of cardiovascular in male and females. About 60% of the deaths are caused by cardiovascular disease. In the SEPHAR III study, which ended in 2016, the general hypertension prevalence about 45%, 12% prevalence of diabetes, 73% of dyslipidemia. Approximately 1/3 of Romanians are overweight, and 1/3 are obese. Tobacco use is also high; the Global Audit Tobacco Survey in 2011 showed that it is an important signal for the young people.

The level of English speaker in Romania GPs is very low, approximately between 5 to 10% and the average family doctor’s age is 55, 56 years.

Overall, GPs in Romania want to learn from other health systems, to learn how to be better practitioners and better managers of our practices. We want to improve the curriculum for our specialty, to improve our knowledge of cardiology, which then we share with the other family doctors. We want to participate in various research and programs that we could develop in Europe, and to strengthen the role and the position of the family doctors in preventing and treating cardiovascular disease.