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Smartphones and special devices that transmit data via Bluetooth will remind elderly patients over 65 years when to drink their medications, when it is time to measure their blood pressure, pulse or when to go for a check-up.

This is a plan of the European Commission, supported by the Sofia Mayor Yordanka Fandakova, by the Sofia Municipality and district “Triaditza”. The pilot plan includes 100 retirees with at least one chronic disease, said the manager of the program Dr. Stoycho Katsarov from the Center for Protection of the Rights in Healthcare. “The goal is better health, safety and independent living for Bulgarians over 65 years,” added Dr. Katzarov. The analysis of the results will be used by the European Commission to develop a European policy for integrated health and social care.

The selected in Bulgaria patients satisfy the conditions to not be accommodated in a rest home, to be a receiver of at least of one social care service like a social or personal assistant, patronage, to be at risk of isolation and to not suffer from severe mental disorders. The smartphones and devices they have been given will not only monitor their life indicators, but also their body weight, the environment temperature, and their locomotor activity.

“All the data will be collected in a database, and it will register the medical and social care services received by the senior (meaning the diagnoses, the therapies, and the check ups),”- said Dr. Katzarov.

The expert said that an all-day call center will be built for a permanent connection with the project participants. It will include GPs and social workers. “The project is for the period of three years, and it was launched on the 1^st of February this year, but the monitoring of patients starts on the 1^st of February 2015,” – said Dr. Katzarov.

The cost of the initiative is € 5,000,000. Bulgaria receives € 500 000 and 250 000 of them – is non-repayable. “Once the program is completed, we can determine what kind of services seniors require, what are the problems they most often encounter. And our health and social services will know in which direction to focus their efforts and what is the required care, which we now lack that has to be provided,”- said the doctor. According to the EC this is the only way we can effectively manage the demographic changes and lifestyles in Europe and to focus on the lives of the elderly.

In connection with the upcoming holidays and the days off work the NHIF informed that the general practitioners and specialists can prescribe, and pharmacies – grant, medicinal products to the insured persons earlier than the stipulated 30 days.

The next prescription should be made on the date when the received by the insured person medicines, dispensed on prescription from the last two visits to the pharmacy, are finished.

The period for which the prescribed drugs dispensed on the previous occasion and the holiday one should last is reflected in the ambulatory sheet. It and the new prescription form record the exact date for the next drugs prescription.

In healthcare money is never enough anywhere, even in the richest countries, stated the manager of the NHIF Dr. Rumyana Todorova in response to the question whether she was pleased with the NHIF budget for 2015. “But if we concentrate, we should say ‘yes’”, – she indicated and pointed out once again that the sum is by BGN 252 million more than the originally adopted by the Parliament budget for 2014

„In my view, the money would not be enough“,- she said just the same and explained: „Relative tranquility will be brought into the system, but there are certain objective laws in healthcare, which, no matter what the budget is, no matter how well calculated it is, cannot be covered 100%.” Dr. Todorova noted that there is a continuous increase in the number of patients and once again noted that the annual average number of cancer patients increases by about 9000, which means nearly BGN 70 million to the NHIF. “Of course, this is related to the constantly improving diagnosis and new technologies. On the other hand, the access to better medicines prolongs life and enhances the credibility of the institution and the resorting of patients to the mandatory health insurance increases, “- she said.

According to the manager of the NHIF there will be a change, but it can not happen all of a sudden. “For me 2015 will be a buffer year, during which we will work on legislative changes and at the same time we will use all the opportunities for the control and correct targeting of cash flows, while these reforms are taking place,” she said, adding that according to her a year is absolutely sufficient to lay the foundation for the changes.

Dr. Todorova said that the medical referrals will not become inapplicable in 2015 and that they are a form of control in outpatient care. “On the other hand there is a proposal by the BMA for them to participate in the methodology for the allocation of funds to hospitals and to participate actively in the control. There is even a proposal by them for 90% of the resources which were actually paid the Health Fund in 2014 to be distributed for 2015,” – she informed.

Regarding the problem with the drug costs the NHIF manager commented: “Drugs are in the hands of the physician and logically it has to be so. The doctor is the one who will choose which medication to use, what is the most suitable thing for the patient. No financial institution can say that. Perhaps this is the place where the insurance institutions should become operative. I.e. there should be an additional resource, because with this resource the Fund cannot cover everything.” She brought up the medicines for rare diseases as well, which were transferred to the NHIF in 2011. At that time the Fund paid for them BGN 24 million, while now the amount is BGN 69 million, reported Dr. Todorova.

And, once again the manager of the NHIF brought up the slashed control capacity of the Fund regarding the money that has been spent by it. She indicated that the financial penalties, which the institution can impose if irregularities are detected, range between BGN 200 and 500, and asked: “Should not the sanctions in the “Control” department be more serious? Should they only be in cash? Should we focus on terminating the contract with the establishment, if it has not performed the action? ”

The state has to warm to its role, summed up Dr. Rumyana Todorova and clarified: “As well as to pay its health insurance contributions as much as we pay and to warm to its role of a regulator and guardian of this system.”

A package of legislative measures, which based on their administrative deadlines could come into force in February, was published for public comment last week on the website of the Ministry of Health. The next year measures include a transfer of activities from inpatient to outpatient care, clearer rules for long-term negotiating the prices and volumes of medicines and more stringent conditions for opening new pharmacies and hospitals. This was announced by the Minister of Health Dr. Peter Moscov from the rostrum of the National Assembly during the presentation of the draft budget of the National Health Insurance Fund for 2015. According to him, the proposed budget provides system security.

The focus of the institution for next year is to improve the quality in the healthcare establishments with which the Health Fund is already working, and the possibility of new hospitals to conclude a contract with the Fund will be limited to a maximum. The restriction is recorded in the transitional and final provisions of the NHIF budget, where it is stated that medical institutions which after December the 31^st, 2014 received their first permit for medical activities, as well as medical establishments with new activities, cannot conclude contracts and additional agreements with the National Health Insurance Fund till the end of 2015.

Additionally, in the middle of the next year a working group with representatives of the state, the Health Insurance Fund and the Medical Association will prepare an annex to the National Framework Agreement for 2015, which will indicate the diseases which could be transferred from inpatient care to outpatient care and thus expenses can be reallocated, pointed out Moskov.

Another idea is the proposal to the Pharmaceutical Union that is being prepared, according to which new pharmacies may be opened only in places where there are none according to the state standards. Furthermore, according to the Minister, the Health Ministry is in an advanced process of signing a Framework Agreement with pharmacists in which are determined the funding and volumes of drugs for years to come.

The parameters of the new drugs that will be entered into the positive list necessarily have to be negotiated in advance, is convinced Moskov. At a later stage the introduction of an electronic drug market is being considered. This exists in many countries and has been proven to reduce the cost of the procedures. Such a market would allow hospitals to conduct tenders electronically and would ease the requirements for bidders, which would put at an equal basis the small and the large companies.

There are beta-blockers (BB), which do not affect the glycemic metabolism in patients with type 2 diabetes (DT2) complicated with heart failure (HF) and carvedilol even improves the regulation of glucose – showed the results of an observational study published in the journal Cardiovascular Diabetology.

The prognostic significance of BB in patients with systolic heart failure has long been known, but in diabetics the treatment with BB is suboptimal (drugs are not included or the dose is not optimal).

This fact may have important clinical implications for patients, since in some 12% of the patients with DT2 is observed systolic heart failure, and in the group with HF – 6 to 25% are diabetics. Therefore, for the proper treatment of this population it is particularly important to use BB which allow to maintain good glycemic control.

Earlier, in the study GEMINI (GEMINI – The Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives), in hypertensive patients with DT2 who did not have systolic heart failure, the administration of carvedilol was associated with beneficial effects on the metabolism of glucose (most probably, due to the increased uptake of glucose) compared to metoprolol tartrate.

The treatment with carvedilol did not affect the glycemic control (did not lead to a change in the baseline of glycosylated hemoglobin A1c) while achieving an improvement in insulin sensitivity and a decrease the progression of microalbuminuria compared with metoprolol tartrate, concluded the authors of GEMINI.

The aim of this study was to evaluate the effect of two different BB: the non-selective BB carvedilol and the beta 1 selective BB bisoprolol on glycemic control, the lipid profile, the renal function and microalbuminuria in patients with HF and DT2.

125 people took part in it, without BB therapy before enrollment. 80 of them started treatment with carvedilol, and the remaining 45 – with bisoprolol, with gradual titration to the maximum tolerated dose, which was 26.5 ± 21.1 mg daily for carvedilol and 5.8 ± 3.0 mg daily for bisoprolol.

The rest of the therapy was carried out according to the recommendations for the treatment of HF. The average follow-up period in the carvedilol group was 1.9 years, and in the bisoprolol group – 1.4 years. The two treatment groups did not differ considerably in terms of demographic characteristics, ejection fraction of the left ventricle, functional class of heart failure and concomitant therapy.

Patients treated with carvedilol had significant reductions in glycosylated hemoglobin levels (HbA1c) – from 7.8 to 7.3, compared to the ones on therapy with bisoprolol where the values of HbA1c were not significantly lower – from 7.0 to 6.9.

The glomerular filtration rate (GFR) showed a decrease in the course of study, without significantly differing depending on the applied BB. The percentage of patients with microalbuminuria remained stable during follow-up. No significant changes in lipid profile were observed.

This study, with a sufficiently long follow-up period, was able to prove that carvedilol did not worsen glycemic control and the lipid profile – its administration even lead to significant reduction in the baseline HbA1c

Tchaikapharma – High Quality Medicines Inc. produces licensed Dilatrend (carvedilol) and is a Marketing Authorization Holder of the product.

Dilatrend has been in the list of NHIF since the 16^th of November 2014, with the following codes:
Dilatrend 6.25 mg x 28 tabl. – CG 221
Dilatrend 12.5 mg x 28 tabl. – CG 220
Dilatrend 25 mg x 28 tabl. – CG 219