Background: Currently, only two centers for diagnosis and treatment of growth disorders are operating in the Western and Eastern parts of Bulgaria. About 200 children are currently GH treated while at least as many children with growth disorders from mostly Central Northern and Southern Bulgaria are presumably not diagnosed. Thus inequalities in children's access to health care are created. In order to correct this and to quickly align practices between existing tertiary centers, the twinning program "Partners4Growth" was created, discussed and accepted nationally.
Results: The Program in the Pleven region, Central Northern Bulgaria (49,917 children), started in February 2018 under the active supervision from the Varna Expert Center of Rare Diseases (VECRED), University Hospital of Varna. Twinning started with e-mail communications, monthly videoconferences and exchanges between institutions. First patients' evaluation and GH stimulation tests in Pleven were done on place under the supervision from the experienced Varna team. Part of the laboratory tests were performed at VECRED initially and locally after the end of the first year. Since the start, 63 short statured children were screened, 17 (26.9%) were diagnosed with rare growth condition, and half of them (52.9%) started GH treatment with excellent initial results. For a period of 12 months, we treated a total of 9 children (55.6% male) with average age at the start of GH therapy of 9.56±3.7 years and average growth velocity of 10.24±4.0 cm/year.
Conclusion: The twinning enabled the quick training in initial work-up, start of GH treatment and follow up of patients of the local team. Possibilities for successful diagnosis and treatment of growth disorders on place were created within one calendar year. The next steps aim to create local multidisciplinary team expertise, acquire more experience and self-confidence while still communicating with the supervisors and thus, improve quality of care.
19 Sep 2019 - 21 Sep 2019