In Latvia Yesterday, 20:502 WATCH Around 300,000 people in Latvia have not visited a family doctor for several years

This was the agreement of the associations uniting family doctors with the Ministry of Health and the National Health Service (NVD). An additional 5.5 million euros will be allocated for these purposes, also so that doctors can hire the necessary assistants to perform this work.

One of the promises of the Ministry of Health, how to improve the low disease prevention indicators, is one of the promises of the Ministry of Health. “It could be an additional person calling these specific groups that would need attention so that they don’t forget to leave, go to that screening, do they get their invitation letter. And do they have any other activities planned, so to speak , which would only benefit their health,” says Antra Valdmane, Deputy State Secretary of the Ministry of Health.

Olga Valciņa, head of the association of oncology patient organizations “Onkoalianse”, says about the planned calling of patients who have not been seen for a long time: “An excellent initiative as a start, but we think that this matter should not end there. There should be at least three nurses in a family doctor’s practice, where one can follow for the patient to come at least once a year and do what needs to be done according to his gender, age, etc. The fact that we don’t have time and don’t want to run to the doctor, because we feel good, doesn’t mean that we don’t have to go. And the section of general practitioners is the one that can make a huge contribution both to cancer diagnosis and to the improvement of mortality data.”

According to NVD calculations, almost three hundred thousand people (299,726) have not visited a family doctor in the last three years. Since the data was selected automatically, this number also includes children born this year. But it is a small part. Another small part could be people who actually live abroad, but have not officially registered this fact.

In a medium-sized doctor’s practice, there might be two or three hundred people who should be called. About half of the long-lost patients should be called by the end of the year, and it is planned that 10-20 percent of them could also come for a face-to-face visit. It would be a conversation about vaccinations, preventive examinations, and cancer screening.

The low response to cancer screenings is one of the biggest criticisms of the health care system established in Latvia in the audit conducted by the State Audit Office.

“Many probably don’t say it out loud, but think that it won’t affect me, it can affect everyone else, but not me, everything is fine with me, everything will be fine with me too,” I would often hear the opinion of patients about why they have not been treated in time examinations, retells the chairman of the board of the Association of Latvian Oncologists, RAKUS oncologist, chemotherapist Alinta Hegmane.

But when the patient finally meets an oncologist, the treatment is often difficult, long and expensive – only forty percent of malignant tumors are detected in the initial stages. Early cancer diagnosis is a priority only on paper, but there are a number of obstacles to the effective use of formally created opportunities.

In the survey of family doctors conducted by the State Audit Office, approximately one-fifth admitted that they do not invite patients to preventive examinations. But the auditors doubt that everyone else would do it systematically enough. “Yes, it was a survey of family doctors, and it is a self-assessment, but there was also a second question, do you have the contact information of the patients available. And there the answers indicated the opposite, that unfortunately we do not have the contact information, but yes, we invite the patients , which from an audit point of view gives us a reason to question the objectivity of these statements,” says Maija Āboliņa, a member of the State Audit Council.

Another option for early diagnosis is cervical and breast cancer screenings, to which the state sends an invitation. Until this year – in paper format to the declared address. In May, invitations also started to be sent as electronic letters to the specified e-mail address. Screenings for bowel cancer and prostate are carried out through the GP. Since the start of the first three mentioned screenings 14 years ago, the response has gradually increased, but is still lower than the average in the European Union.

“Formally, everything is fine with us, letters are sent to the target group, but if the response is 25 or 40% or 2% – it is not screening. And the reasons must be analyzed. Here it was very well shown in the report that the invitation letter is , but that patient disappears in the middle between the invitation letter and the examination itself. If something is wrong, the family doctor can, in my opinion, the family doctor, the family doctor’s sister could be the stage that could increase this response,” says Alinta Hegmane.

Response to cervical cancer screening increased from 15 percent in 2009 to almost 44 percent in 2018, then decreased, but last year the response increased to 46.7 percent. In the first half of this year, they are already more than 60 percent. (EU guidelines – 70%, EU average 60%).

Response to breast cancer screening doubled in the first ten years – from 21 percent to about 40 percent, fell during the covid and was around 30 percent in the last three years. (EU guidelines – 70%, EU average 54%).

Intestinal cancer screening started with less than seven percent response in the target group, but in the last two years it has been around 19 percent. (EU guidelines – 45%, EU average 48%),

The auditors and NVD are divided about the response to prostate cancer screening, which was started only 2 years ago. According to the auditors, the response rate in the target group is 2%, while NVD emphasizes that it is 50%, because probably the family doctor sent him for examination, but no code indicating preventive cancer screening was entered into the system. Importantly, about half of men over 50 who do not have a tumor have had such a test.

However, being on the screening is not enough. And it turns out that even if a tumor is suspected in the screening, patients do not take the next steps.

Apparently, the lowest response is when cervical cancer is detected in the preventive examination. For example, in 2021, only a quarter of women had further examinations. However, it is impossible to state unequivocally that this is really the case, because if the patient chooses paid medicine for the future, she will not appear in the statistics.

Such a possibility is only theoretical. And this means that Latvia does not have a complete picture of the path of oncology patients. “We have also created statistical manipulations, where the family doctor can enter about the paid services performed for patients. But this requires the patient to provide the family doctor with information that he has performed this examination for a fee, and also for the family doctor to enter statistical information,” explains NVD Yuliya Voropayeva, Deputy Head of Outpatient Services Department.

In breast cancer screening, tumors are detected in ten percent of those examined, bowel cancer – in six percent. And even among these patients, only two-thirds use further examinations and the green corridor.

Also, there is probably someone here who uses paid medicine. But patients also disappear in the chaotic system. “The convenience of data availability is so complicated that we are not able to respond flexibly, quickly, and track them – we had to go to each patient individually to see if he was present or not, and it was a very time-consuming process. In recent years, things have become a little more organized system that we can more easily retrieve data on which of our patients have been invited and how many of them have done something,” says the president of the Latvian Association of Family Doctors.

“We have a mess as to how the patient arrives at the answer after he has responded and gone and given this test material here – it is different, it is left to the medical authorities, and if the person is not receptive himself and again does not knock on the right door where he can get the answer, then it is very likely that people, not realizing the risk, remain without feedback,” says the member of the State Audit Council.

During the audit, the Ministry of Health finally determined that the Center for Disease Prevention and Control will be the one to monitor the screening process in the country as a whole. And committed to fulfilling the recommendation – to approach the average in the European Union in screening indicators within five years.

The new Minister of Health Hosam Abu Meri (JV) states that he has several ideas to improve the situation, emphasizing both patient education and digitization, for example, so that people receive reminders about preventive examinations in a similar way to reminders from CSDD.

“We have felt devalued for years. And the entire health care system, which says in every election that we are a priority. This is cynicism year after year, because health care has never been a priority in life. For any government,” says Alice Nicmane-Aišpure.

In Latvia, mortality from malignant tumors is the highest among the Baltic States and 15% higher than the average in the European Union.