Patient experience with primary health care during the COVID-19 pandemic in Bulgaria

BACKGROUND: The COVID-19 pandemic has had a profound impact on the primary healthcare experience of patients. Restricted access, delays in routine services, postponed checkups owing to safety concerns led to disruptions in care, missed diagnoses, and delays in treatment. This study investigates primary care service obstacles faced by patients during the COVID-19 pandemic in Bulgaria. METHODS: A national cross-sectional survey was conducted between November and December 2021 by a poll agency using an online self-administered questionnaire with 800 respondents. Binomial logistic regression was used to examine the association between sociodemographic variables and issues related to the availability of primary care services. RESULTS: Around 32% (95% CI 28-35%; p < 0.001) of the respondents reported obstacles related to the primary care, and 25% (95% CI 22-38%; p < 0.001) postponed a visit to the general practitioner due to accessibility and availability issues or fear of infection. The most prevalent obstacle cited by patients was a refusal of a referral for specialized care (26%), followed by a refusal of an out-of-hours or weekend consultation in case of urgent need (25%). Home visits and routine examinations were also denied to patients, albeit less frequently. The multivariable analyses found associations between gender, health status, education, and impediments by obtaining primary care services. The odds of facing obstacles rose as self-rated health deteriorated (OR = 6.0, p < 0.001). The likelihood of experiencing availability issues increased with educational level (OR = 6.2, p < 0.001). Women were 1.6 times more likely (p = 0.009) to report difficulties with primary care. CONCLUSIONS: The COVID-19 pandemic has created significant barriers for many patients to access primary healthcare services. In addition, it has highlighted the need for a primary healthcare system that is resilient and capable of maintaining its essential functions during public health emergencies. KEY MESSAGES: • Primary health care has a crucial role in supporting patients during public health emergencies. • The health system needs resilient primary health care that can adapt to swiftly changing conditions.