Research Article
The Opinion of General Practitioners, Medical Students,
and Other Medical Specialists on Palliative Care in Bulgaria
G. Foreva,
1
R. Asenova,
1
and M. Semerdjieva
2
1
Section General Medicine, Public Health Faculty, Medical University Plovdiv, 15A Vassil Aprilov Street, 4002 Plovdiv, Bulgaria
2
Department Health Care Management, Public Health Faculty, Medical University Plovdiv, 15A Vassil Aprilov Street,
4002 Plovdiv, Bulgaria
Correspondence should be addressed to G. Foreva; gforeva@dir.bg
Received 3 June 2013; Accepted 10 December 2013; Published 30 January 2014
Academic Editors: G. Becker, D. Heigener, and C. Knapp
Copyright © 2014 G. Foreva et al. Tis is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
In Bulgaria, the patient is entitled to palliative care in case of incurable disease with an unfavourable prognosis. Palliative care is
provided by the family doctor/GP and institutions. Literature on palliative care providing is scarce. Te objective of the study was to
investigate the opinion of general practitioners, medical students, and other medical specialists working in institutions on palliative
care. Method. We have developed a structured questionnaire. Descriptive statistics have been calculated for all items. Diferences
between groups have been compared using u-criterion. Level of signifcance was < 0.05. Data has been analyzed using SPSS v.
16. Results. A total of 518 respondents completed the survey. Lack of appropriate organisation and fnancing has been pointed out
by all participants. Te GP’s role in palliative care providing has been described as a contradictory one. Te criteria on the basis of
which the patients are eligible for palliative care have been arranged in the same way by all respondents, but GPs chose the longest
temporal indicator. Quality assessment has not been applied. 2/3 of respondents demanded palliative care training. Conclusion. On
the whole, the investigated groups difered to some extent in their opinion on palliative care both on conceptual and practical levels.
1. Introduction
In the last 20 years, demographic development in Bulgaria has
been characterized by population decline, a low birth rate, a
high mortality rate, and ageing population.
Health care reforms afer 1989 have provided changes in
the structure and management of the health system; GPs
have been established as providers of primary care and
gatekeepers; the main fnancial source has been obtained
from compulsory health insurance contributions in National
Health Insurance Fund (NHIF). In spite of that fact, citizens
as well as medical professionals are dissatisfed and the need
for further reform is pronounced, particularly in view of the
low health status of the population.
Te term palliative care includes both the philosophy
and organization of an approach that increases the quality of
health care in three directions: alleviation of sufering, com-
munication improvement, and coordination of care in dif-
ferent settings. Palliative care in Bulgaria is underdeveloped
regarding both community-based services and inpatient care;
it has been provided by general practitioners, health institu-
tions for out-of-hospital and hospital-based care, oncological
health centres, and hospices and fnanced by compulsory
health insurance. Moreover, the availability of palliative care
facilities is insufcient. In most cases, patients tended to stay
at family home, mainly because of fnancial reasons. Patients
directly pay nursing homes. Te only clinical path in palliative
care is for oncological patients in terminal stages. Tus, in
general, palliative care is not organized well, and the role
of general practitioners and other medical and nonmedical
specialists in providing it is not established. Researches in
this feld are insufcient and there is scarcity in the scientifc
literature. Te objective of the study was to investigate the
opinion of general practitioners, medical students, and other
medical specialists working in institutions, on palliative care,
focused on (1) organization, (2) GPs’ role, (3) identifcation
of patients, (4) quality, and (5) medical specialists’ training
needs in palliative care.
Hindawi Publishing Corporation
International Journal of Palliative Care
Volume 2014, Article ID 631798, 4 pages
http://dx.doi.org/10.1155/2014/631798