New payment rules in the National Framework Contract (NRD) for 2026-2028 will make it harder to diagnose and treat stroke, neurologists warned at the BTA National Press Club.
Deadlines in two of the clinical pathways do not match, and the pathway for transient ischaemic attack needs to be rewritten, they said.
The speakers were Dr Filip Alexiev, chairman of the Bulgarian Stroke Society, Assoc Prof Rosen Kalpachki, the society's founder, and Georgi Georgiev, deputy chairman of the Stroke and Aphasia Association, together with colleagues from Sofiamed hospital.
The contract was signed in early September and published in the State Gazette on 25 September. The neurologists say neither they nor their Sofiamed colleagues were invited to discuss the clinical pathways or the contract itself, and took no part in it.
In stroke, everything depends on time and every minute counts, Dr Alexiev said. Treatment with thrombolysis must start within 4 hours, and with thrombectomy within 6 hours, depending on the patient's condition.
The pathway for transient ischaemic attack requires doctors to wait an hour before they establish symptoms and therapy. This does not meet modern medical criteria, he said. Doctors cannot wait an hour and only then decide whether and how to treat a stroke. The rules for imaging are also poorly defined, and some of the tests amount to overdiagnosis, Dr Alexiev said.
Assoc Prof Kalpachki said the changes in stroke treatment are more likely to make things harder for patients than better. The extra requirements have no serious medical basis and slow down treatment, he said.
The aim is a network of stroke treatment centres, but the administrative rules get in the way of doctors, he said. All citizens should have equal access to treatment, but the clinical pathways will not ensure complete treatment and care. Care for patients after they leave hospital has not changed, and there is still no national plan to fight stroke, he said.
Georgi Georgiev said stroke patients need a team approach from several specialties, and the whole system should be ready to receive a patient no matter where they live.
Specialists in prevention, early diagnosis, treatment, rehabilitation and long-term care for stroke patients will gather at the Fourth National Congress of the Bulgarian Stroke Society in Sofia on 23-25 October. They will share knowledge, present the latest scientific advances and discuss good clinical practice.