Factors for prolonged hospital length of stay in discharged patients with COVID-19

Hospitals were overburdened during peak periods of Coronavirus disease 2019 (COVID-19) pandemic, and bed occupancy was full. The ability to predict and plan patients' hospital length of stay allows predictability in terms of the free capacity of hospital facilities. The purpose of this article is to evaluate the factors that influence the hospital length of stay among discharged (recovered) from COVID-19 patients. This will allow the prediction of the likely number of bed days in the conditions of intensive workload of medical facilities for hospital care. A total of 441 discharged after hospital treatment for COVID-19 patients are followed up. Factors for prolonged hospital length of stay are searched among the indicators recorded at admission. Median hospital length of stay of the patients discharged from COVID-19 ward is 9 days (IQR 6-12) and in the COVID-19 intensive care unit 12 days (IQR 9.75-18.75). The median length of stay assessed by a survival analysis is 35 days in the COVID-19 unit and only 8 days in intensive care, due to the high mortality in the intensive care unit. The longer hospital length of stay of patients discharged from the COVID-19 wards is associated with the presence of hypertension (median 10 vs. 8 days for patients without the disease, p=0.006), ischemic heart disease (10 vs. 8 days, p<0.001), cerebrovascular disease (10 vs. 8 days, p=0.061 - did not reach significance), peripheral arterial disease (12 vs. 8 days, p=0.024), chronic renal failure or chroniodialysis (14 vs. 8 days, p<0.001), oncological illness (11 vs. 8 days, p=0.024), presence of at least one comorbidity (9 vs. 8 days, p=0.006), arrival at the hospital by ambulance vs. the patient's own transport (11 vs. 8 days, p=0.003), severe lung involvement shown on X-ray (10 vs. 8 days, p=0.030) or CT (18 vs. 10 days, p=0.045). Prolonged hospital length of stay is associated with older age (Spearman's rho=0.185, p<0.001), greater number of comorbidities (Spearman's rho=0.200, p<0.001), lower oxygen saturation on admission (Spearman's rho=- 0.294, p<0.001) and lower lymphocytes count (Spearman's rho=-0.209, p<0.001), as well as higher CRP (Spearman's rho=0.168, p<0.001), LDH (Spearman's rho=0.140, p=0.004), ferritin (Spearman's rho=0.143, p=0.004) and d-dimer (Spearman's rho=0.207, p<0.001). The multiple linear regression model found that the increase in the number of bed days of discharged from COVID-19 unit patients depends on the way the patient arrived at the Emergency Department (by ambulance instead of on their own transportation) and the presence of an accompanying oncological disease (R2=0.628, p<0.001). The hospital length of stay of patients discharged from COVID-19 intensive care unit is associated with the presence of hypertension (median 14 vs. 9 days for patients without the disease, p=0.067 - significance not reached) and at least one comorbidity (14 vs. 9 days, p=0.067 - significance not reached). The number of bed days is higher when recorded more comorbidities (Spearman's rho=0.818, p=0.004), lower oxygen saturation (Spearman's rho=-0.605, p=0.067 - significance not reached) and higher leukocytes count (Spearman's rho=0.546, p=0.102 - significance not reached). A multiple linear regression model demonstrated the hospital length of stay of patients in the COVID-19 intensive care unit as an outcome of the number of comorbidities only (R2=0.826, p=0.003). The ability to estimate and forecast quickly the number of bed-days based on a small number of variables would help reduce the burden on the healthcare system during a pandemic.

General practitioners' opinions on additional financing for work in the conditions of an announced epidemiological situation

The unprecedented restrictions placed in connection with controlling the COVID-19 pandemic lead to less activities being performed in primary health care (PHC), which lowered the National Health Insurance Fund' contractual payments to the providers of PHC. In practice, the general practitioners (GPs) were one of the providers at the front of the fight with COVID-19. Additional financing for working in the unfavorable conditions of an announced epidemiological situation was negotiated to compensate the measured drop and the extraordinary workload in PHC. This was done with the Methodology of the National Health Insurance Fund (NHIF) from 2020. In this regard, the goal of the current research is to study the opinions of GPs on the additional financial stimulation introduced in the practice of PHC for work done in case of an announced epidemiological situation. The results of the questionnaire survey conducted among 394 GPs from the whole country - contractual partners of the NHIF - during the June 2022-October 2022 period, show that a share of respondents, who are happy with the measures taken for financial help in PHC practice, is small. As little as 12.2% of them find the rules about a payment of up to 85% of the determined base price in PHC to be fully adequate. The share of GPs, who are fully satisfied with the additional pay they received in the period November 1 2020-April 30 2022, is smaller (10.4%). A predominant number of GPs report an overall displeasure (dissatisfaction) with the compensation mechanism for the lowered workloads in PHC and the additional pay. A little over half the PHC practices covered (52.3%) have hired specialists in "Healthcare", who were also financially stimulated with additional monthly pay for the period November 1 2020-April 30 2022. The rest (47.7%) work without hiring such specialists which further burdens the GPs. All of this necessitates policies to stimulate the work of GPs, both in financial and professional terms.

THE REGULATION BY THE NHIF IN THE CONTEXT OF COVID-19 IN OPINION OF GENERAL PRACTITIONERS.

The regulation over the expenditure of public funds for health is carried out by the only institution in the Republic of Bulgaria, which is responsible for the activities of the compulsory health insurance-the National Health Insurance Fund (NHIF). At present, research in the area of control related to the legal and effective expenditure of the statutory funds at the first level of medical care is not sufficiently covered. The aim is to clarify the degree of appropriateness in terms of control over the implementation of contracts for the provision of primary outpatient medical care (POMC) in the context of COVID-19, as well as to reveal gaps and bad practices in the control process, which will help to formulate recommendations for its optimization. The article presents the results of a survey conducted among 394 GPs across the country for the period from 23.06.2022 to 16.10.2022 using the online platform Google Forms. The results show that among two-thirds of the surveyed GPs (71.6%) there are suspicions of an unjustifiably high number of activities rejected for payment by the Fund. In one third of the surveyed GPs, another type of control by the NHIF was significantly more frequent in district centres (43.1%) compared to other localities (29.1%). Nearly half of the GPs (45.8%) were covered by inspections based on complaints from dissatisfied citizens. The main findings imply that appropriate action needs to be taken in the direction of optimizing control by the NHIF in order to raise the authority of the controlling institution perceived by POMC contractors.Copyright © 2022, Central Medical Library Medical University - Sofia. All rights reserved.

THE REGULATION BY THE NHIF IN THE CONTEXT OF COVID-19 IN OPINION OF GENERAL PRACTITIONERS.

The regulation over the expenditure of public funds for health is carried out by the only institution in the Republic of Bulgaria, which is responsible for the activities of the compulsory health insurance-the National Health Insurance Fund (NHIF). At present, research in the area of control related to the legal and effective expenditure of the statutory funds at the first level of medical care is not sufficiently covered. The aim is to clarify the degree of appropriateness in terms of control over the implementation of contracts for the provision of primary outpatient medical care (POMC) in the context of COVID-19, as well as to reveal gaps and bad practices in the control process, which will help to formulate recommendations for its optimization. The article presents the results of a survey conducted among 394 GPs across the country for the period from 23.06.2022 to 16.10.2022 using the online platform Google Forms. The results show that among two-thirds of the surveyed GPs (71.6%) there are suspicions of an unjustifiably high number of activities rejected for payment by the Fund. In one third of the surveyed GPs, another type of control by the NHIF was significantly more frequent in district centres (43.1%) compared to other localities (29.1%). Nearly half of the GPs (45.8%) were covered by inspections based on complaints from dissatisfied citizens. The main findings imply that appropriate action needs to be taken in the direction of optimizing control by the NHIF in order to raise the authority of the controlling institution perceived by POMC contractors.Copyright © 2022, Central Medical Library Medical University - Sofia. All rights reserved.

Evaluation of risk factors for barotrauma complications in COVID-19 patients treated with high flow nasal cannula (HFNC)

Aim: To evaluate risk factors for barotrauma development in COVID-19 patients treated with HFNC. Method(s): 34 COVID-19 patients are studied retrospectively, 24 males, mean age 61,74 years. Symptoms (dyspnoea, cough, fever, hemoptoe, fatigue), comorbidities (arterial hypertension (AH), COPD, asthma, diabetes, heart and kidney diseases, bronchiectasis), blood tests (total blood count, neutrophils to lymphocytes (Neu:Ly) ratio, lactate dehydrogenase (LDH), ferritin, interleukin-6, C-reactive protein), chest X-ray findings at admission are assessed. Need for oxygen therapy (ambient air, low flow therapy, HFNC) during the hospitalisation, barotrauma development (pneumothorax (PT), pneumomediastinum (PM), subcutaneous emphysema (SE)) and disease outcome are analysed. Result(s): Age decrease by 1 year leads to increased risk of SE by 17% (hazard ratio (HR)0.852,p=0.018). LDH increase by 1 U/l leads to 0.4% increased risk of SE (HR1.004,p=0.020). Age and LDH level are proved as risk factors for SE. AH increases the risk of PM by 27.5% (HR1.275,p=0.087). Ferritin increase by 1 ug/l leads to 0.2% higher risk of PT (HR1.002,p=0.019). Multivariate model reveals AH (HR1.777,p=0.057) and ferritin level (HR1.004,p=0.013) as risk factors for barotrauma. Multivariate model shows LDH (HR1,003,p=0,023), ferritin (HR1,004,p=0,007), and Neu:Ly (HR1,123,p=0,059) as main risk factors for PT,PM, SE. Dyspnoea increases the death risk 11 times (HR11.2,p=0.034) while LDH increase by 1 U/l leads to 0.1% increased death risk (HR1.001,p=0.087). Conclusion(s): AH, age, ferritin, LDH, Neu:Ly levels are proved as risk factors for PT, PM and SE. Dyspnoea is a risk factor for death outcome.

ATTITUDES TOWARDS VACCINES AGAINST COVID-19 IN BULGARIA

This research registered attitudes towards COVID-19 vaccines among Bulgarians above the age of 16 years and shows a clear division in society on the matter. The proportion of those who trust vaccines is equal to the proportion of those who would not accept a vaccine against the coronavirus infection. The research took place immediately after the beginning of the national vaccination campaign in Bulgaria and allows for further research on the factors of the polar opinions in society. Although those factors are not subject to this research, the anti-vaccine movements and attitudes in Bulgaria and abroad were taken into consideration as those traditionally have an impact on the immunization coverage in our societies. In the process of the survey implementation, the research team directly observed some anti-vaccine movements and their constant efforts to undermine the public efforts for curbing the pandemic. © 2021, Central Medical Library Medical University – Sofia. All rights reserved.

PREVENTION OF SEASONAL INFLUENZA IN THE CONTEXT OF COVID-19 PANDEMIC

The registered incidence of influenza and acute respiratory diseases (ARD) in Bulgaria remains low in the epidemic period of time during 2020-2021, in the absence of a clear epidemic curve. For the first year during the winter season, influenza viruses were not detected. Continuation of restrictive and preventive measures related to the COVID-19 pandemic and the increase in influenza vaccination coverage enable maintaining the influenza activity at low levels during the winter season. It is required to perform a thorough assessment of the effectiveness of preventive and anti-epidemic measures and the possibilities for their implementation in the following seasons to limiting the spread of influenza and ARD.

THE IMPACT OF THE COVID-19 PANDEMIC ON THE FUNCTIONING OF DENTAL PRACTICES AND THE GENERAL HEALTH OF PATIENTS IN BULGARIA

The COVID-19 pandemic, beginning in December 2019, spanning the world in 2020 and evolving till now, has had a profound impact on all activities, functions and areas of society. In particular, the functioning of both dental practitioners and general practitioners is affected. The pandemic had a strong impact on the work process of physicians, the health status of patients and, accordingly, economic well-being and prospects. The aim of the present study is to establish the extent of the impact of the COVID pandemic on the functioning of dental practices, general practitioners and the health status of patients in Bulgaria.

Attitudes towards vaccines against COVID-19 in Bulgaria

This research registered attitudes towards COVID-19 vaccines among Bulgarians above the age of 16 years and shows a clear division in society on the matter. The proportion of those who trust vaccines is equal to the proportion of those who would not accept a vaccine against the coronavirus infection. The research took place immediately after the beginning of the national vaccination campaign in Bulgaria and allows for further research on the factors of the polar opinions in society. Although those factors are not subject to this research, the anti-vaccine movements and attitudes in Bulgaria and abroad were taken into consideration as those traditionally have an impact on the immunization coverage in our societies. In the process of the survey implementation, the research team directly observed some anti-vaccine movements and their constant efforts to undermine the public efforts for curbing the pandemic.

Impact of anti-epidemic measures in Bulgaria on COVID-19 morbidity and mortality

Introduction and Background: In its recent history, humankind has faced many large-scale epidemics, although none of them has reached the pandemic potential of the SARS-CoV-2. The study of a cluster spread of viral pneumonia in Wuhan Province, China, has led to the identification of a novel coronavirus. Aim and Objectives: The aim of this study is to evaluate the effect of the anti-epidemic measures in Bulgaria on morbidity and mortality from COVID-19 throughout the pandemic between February 2020 and April 2021, covering the first, second and third wave of the epidemic in Bulgaria.