{"id":1803,"date":"2020-11-10T15:29:11","date_gmt":"2020-11-10T15:29:11","guid":{"rendered":"https:\/\/practicalhealthpsychology.com\/?p=1803"},"modified":"2025-11-04T14:14:41","modified_gmt":"2025-11-04T14:14:41","slug":"improving-the-delivery-of-brief-alcohol-advice-in-primary-care-views-from-both-sides-of-the-consultation-table","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/cz\/2020\/11\/improving-the-delivery-of-brief-alcohol-advice-in-primary-care-views-from-both-sides-of-the-consultation-table\/","title":{"rendered":"Jak zlep\u0161it protialkoholn\u00ed poradenstv\u00ed v prim\u00e1rn\u00ed p\u00e9\u010di: dva \u00fahly pohledu"},"content":{"rendered":"<p><strong>Amy O\u2019Donnell, Newcastle University, UK<\/strong><\/p>\n<p>V posledn\u00ed dob\u011b poklesla konzumace alkoholu v n\u011bkter\u00fdch \u010d\u00e1stech Evropy, a to zejm\u00e9na u <u>mlad\u00fdch lid\u00ed<\/u>. Nadm\u011brn\u00e1 spot\u0159eba alkoholu v\u0161ak p\u0159esto z\u016fst\u00e1v\u00e1 hlavn\u00edm rizikov\u00fdm faktorem, kter\u00fd vede ke \u0161patn\u00e9mu zdrav\u00ed a p\u0159ed\u010dasn\u00fdm \u00famrt\u00edm. Lidem, kte\u0159\u00ed nadm\u011brn\u011b pij\u00ed, mohou prakti\u010dt\u00ed l\u00e9ka\u0159i nebo zdravotn\u00ed sestry poskytovat doporu\u010den\u00ed<u>, jak konzumaci alkoholu omezovat<\/u>. <u>Poradensk\u00e9 p\u0159\u00edstupy o nadm\u011brn\u00e9m pit\u00ed<\/u>, kter\u00e9 \u010derpaj\u00ed z\u00a0v\u00fdsledk\u016f mnoha v\u00fdzkum\u016f, vyu\u017e\u00edvaj\u00ed formu strukturovan\u00e9 konverzace. Jejich c\u00edlem je motivovat pacienta k\u00a0p\u0159em\u00fd\u0161len\u00ed nad zm\u011bnou chov\u00e1n\u00ed ve vztahu k\u00a0pit\u00ed alkoholu, a t\u00edm zm\u00edrnit jeho negativn\u00ed dopad na zdrav\u00ed. I kdy\u017e nejsou doposud \u00fapln\u011b jasn\u011b identifikov\u00e1ny kl\u00ed\u010dov\u00e9 prvky t\u011bchto rozhovor\u016f, <u>efektivn\u00edmi sou\u010d\u00e1stmi tohoto poradensk\u00e9ho bal\u00ed\u010dku<\/u> se jev\u00ed zejm\u00e9na poskytov\u00e1n\u00ed zp\u011btn\u00e9 vazby pacientovi o konzumaci alkoholu a povzbuzov\u00e1n\u00ed pacienta ke sledov\u00e1n\u00ed (monitoringu) pit\u00ed.<\/p>\n<p><!--more--><\/p>\n<p>Poskytov\u00e1n\u00ed l\u00e9\u010dby zalo\u017een\u00e9 na d\u016fkazech (EBM\u2013 evidence based medicine), kter\u00e1 usiluje o dosa\u017een\u00ed zm\u011bny v rutinn\u00ed zdravotn\u00ed p\u00e9\u010di, je v\u0161ak pomal\u00e1 a choulostiv\u00e1 z\u00e1le\u017eitost. N\u011bkter\u00e9 odhady nazna\u010duj\u00ed, \u017ee trv\u00e1 v pr\u016fm\u011bru a\u017e <u>17 let<\/u>, ne\u017e se v\u00fdsledky v\u00fdzkumu dostanou do ka\u017edodenn\u00ed klinick\u00e9 praxe. Jak se ukazuje z v\u00edce ne\u017e 70 randomizovan\u00fdch kontrolovan\u00fdch studi\u00ed a dal\u0161\u00edch odborn\u00fdch publikac\u00ed, ani po t\u0159iceti letech v\u00fdzkumu se v prim\u00e1rn\u00ed zdravotn\u00ed p\u00e9\u010di b\u011b\u017en\u011b ned\u00e1vaj\u00ed stru\u010dn\u00e9 rady, t\u00fdkaj\u00edc\u00ed se pit\u00ed. P\u0159i p\u0159em\u00fd\u0161len\u00ed nad d\u016fvody, pro\u010d kr\u00e1tk\u00e9 poradenstv\u00ed o pit\u00ed alkoholu nen\u00ed v prim\u00e1rn\u00ed p\u00e9\u010di v\u00edce p\u0159\u00edtomno, se mus\u00edme zam\u011b\u0159it <u>na n\u011bkolik r\u016fzn\u00fdch hledisek<\/u>, a to jak na stran\u011b poskytovatel\u016f p\u00e9\u010de (l\u00e9ka\u0159\u016f), tak na stran\u011b p\u0159\u00edjemc\u016f p\u00e9\u010de (pacient\u016f),<\/p>\n<p>Co n\u00e1m tedy mohou lid\u00e9, kte\u0159\u00ed poskytuj\u00ed protialkoholn\u00ed poradenstv\u00ed v prim\u00e1rn\u00ed p\u00e9\u010di stru\u010dn\u011b nab\u00eddnout?<\/p>\n<p>Mezi <u>b\u011b\u017en\u00e9 probl\u00e9my, kter\u00e9 zmi\u0148uj\u00ed prakti\u010dt\u00ed l\u00e9ka\u0159i a zdravotn\u00ed sestry<\/u>, pat\u0159\u00ed nedostatek \u010dasu na \u0161kolen\u00ed nebo m\u00e1lo finan\u010dn\u00edch zdroj\u016f pro\u00a0poskytov\u00e1n\u00ed protialkoholn\u00edho poradenstv\u00ed. P\u0159esto ani dodate\u010dn\u00e9 pen\u011b\u017eit\u00e9 bonusy za toto poradenstv\u00ed pro praktick\u00e9 l\u00e9ka\u0159e nemus\u00ed b\u00fdt nutn\u011b efektivn\u00ed implementa\u010dn\u00ed strategi\u00ed. V\u00a0Anglii ned\u00e1vno uskute\u010dn\u011bn\u00e1 studie zjistila, \u017ee zaveden\u00ed <u>finan\u010dn\u00edch pob\u00eddek<\/u> u protialkoholn\u00edho poradenstv\u00ed v prim\u00e1rn\u00ed p\u00e9\u010di nem\u011blo t\u00e9m\u011b\u0159 \u017e\u00e1dn\u00fd dopad na to, kolik alkoholu pacienti vypili. Dal\u0161\u00ed v\u00fdzkumy nazna\u010duj\u00ed, \u017ee v\u011bt\u0161\u00ed roli p\u0159i ovliv\u0148ov\u00e1n\u00ed praxe mohou sehr\u00e1t postoje a p\u0159esv\u011bd\u010den\u00ed l\u00e9ka\u0159\u016f, t\u00fdkaj\u00edc\u00ed se d\u016fle\u017eitosti a hodnoty diskus\u00ed o alkoholu b\u011bhem rutinn\u00edch zdravotn\u00edch prohl\u00eddek. N\u011bkte\u0159\u00ed prakti\u010dt\u00ed l\u00e9ka\u0159i v\u0161ak pochybuj\u00ed o tom, \u017ee mohou b\u00fdt jejich pacienti &#8211; a zejm\u00e9na ti s velmi t\u011b\u017ekou z\u00e1vislost\u00ed na pit\u00ed \u2013 k rad\u00e1m ohledn\u011b zm\u011bny chov\u00e1n\u00ed p\u0159i pit\u00ed vn\u00edmav\u00ed. Je to z\u010d\u00e1sti zp\u016fsobeno ned\u016fv\u011brou v \u00fa\u010dinnost psychologick\u00fdch terapi\u00ed p\u0159i nadm\u011brn\u00e9 spot\u0159eb\u011b alkoholu, a tak\u00e9 proto, \u017ee se prakti\u010dt\u00ed l\u00e9ka\u0159i ob\u00e1vaj\u00ed, \u017ee by t\u00edmto p\u0159\u00edstupem na pit\u00ed alkoholu je\u0161t\u011b v\u00edce upozor\u0148ovali.<\/p>\n<p>M\u00e9n\u011b v\u00fdzkum\u016f zkoumalo pohled ze strany pacient\u016f. V\u00fdzkumy ukazuj\u00ed, \u017ee v\u011bt\u0161ina lid\u00ed pova\u017euje za p\u0159ijateln\u00e9, pokud se prakti\u010dt\u00ed l\u00e9ka\u0159i nebo zdravotn\u00ed sestry na konzumaci alkoholu ptaj\u00ed. Poradenstv\u00ed o \u017eivotn\u00edm stylu pova\u017euj\u00ed za cennou sou\u010d\u00e1st zdravotn\u00ed p\u00e9\u010de, a to zejm\u00e9na u osob, kter\u00e9 maj\u00ed v\u00a0d\u016fsledku pit\u00ed alkoholu zdravotn\u00ed pot\u00ed\u017ee. N\u011bkte\u0159\u00ed l\u00e9ka\u0159i stejn\u011b jako pacienti si v\u0161ak nejsou jisti, zda jsou lid\u00e9 o\u00a0probl\u00e9mech s pit\u00edm ochotni s praktick\u00fdmi l\u00e9ka\u0159i <u>pravdiv\u011b mluvit<\/u>. Velkou v\u00fdzvou je n\u00edzk\u00e9 pov\u011bdom\u00ed mnoha pacient\u016f o mno\u017estv\u00ed vypit\u00e9ho alkoholu. To je \u010d\u00e1ste\u010dn\u011b d\u00e1no t\u00edm, \u017ee v\u00fdpo\u010det vypit\u00e9ho alkoholu nap\u0159. ve sklenici v\u00edna nebo ginu s tonikem je pom\u011brn\u011b slo\u017eit\u00fd, a tak m\u016f\u017ee b\u00fdt snadn\u00e9 p\u0159i pit\u00ed doma, kde chyb\u00ed standardizovan\u00e1 opat\u0159en\u00ed, o mno\u017estv\u00ed ztratit p\u0159ehled<\/p>\n<p>Je to \u010d\u00e1ste\u010dn\u011b i proto, \u017ee konzumaci alkoholu mnoz\u00ed lid\u00e9 nevn\u00edmaj\u00ed z pohledu zv\u00fd\u0161en\u00e9ho rizika vzniku konkr\u00e9tn\u00edch nemoc\u00ed (tj. tak, jak vid\u00ed pit\u00ed prakti\u010dt\u00ed l\u00e9ka\u0159i, l\u00e9ka\u0159i &#8211; specialist\u00e9 nebo epidemiologov\u00e9), ale sp\u00ed\u0161e ji vn\u00edmaj\u00ed z hlediska \u00fast\u0159edn\u00ed role alkoholu na oslav\u00e1ch a p\u0159i z\u00e1bav\u011b. To znamen\u00e1, \u017ee se n\u011bkte\u0159\u00ed pacienti mohou zdr\u00e1hat p\u0159iznat, \u017ee pij\u00ed p\u0159\u00edli\u0161 mnoho a divit se, kdy\u017e jim jejich l\u00e9ka\u0159 doporu\u010duje omezit pit\u00ed. V souvislosti s t\u00edmto probl\u00e9mem n\u00e1m pacienti sd\u011bluj\u00ed, \u017ee vyzkou\u0161eli <u>mnoho strategi\u00ed<\/u> zam\u011b\u0159en\u00fdch na sn\u00ed\u017een\u00ed pit\u00ed, ale ty na\u010derpali zejm\u00e9na z \u201elekc\u00ed \u017eivota\u201c ve sv\u00fdch rodin\u00e1ch, od p\u0159\u00e1tel a soci\u00e1ln\u00edch skupin. N\u011bkte\u0159\u00ed pacienti tedy vid\u00ed omezen\u00fd p\u0159\u00ednos poradenstv\u00ed, kter\u00e9 jim prakti\u010dt\u00ed l\u00e9ka\u0159i nebo zdravotn\u00ed sestry ohledn\u011b pit\u00ed nab\u00edzej\u00ed, a kter\u00e9 se jim tak m\u016f\u017ee jevit jako odtr\u017een\u00e9 od skute\u010dn\u00e9ho \u017eivota.<\/p>\n<p><strong>Praktick\u00e1 doporu\u010den\u00ed<\/strong><\/p>\n<p>Jak tedy m\u016f\u017eeme vyu\u017e\u00edt v\u0161echny tyto n\u00e1zory, poznatky a zku\u0161enosti ke zlep\u0161en\u00ed kr\u00e1tk\u00e9ho protialkoholn\u00edho poradenstv\u00ed v prim\u00e1rn\u00ed zdravotn\u00ed p\u00e9\u010di?<\/p>\n<ul>\n<li>Nejprve sami sebe ujist\u011bte, \u017ee pt\u00e1t se na pit\u00ed alkoholu je v po\u0159\u00e1dku. Existuje jen m\u00e1lo d\u016fkaz\u016f o tom, \u017ee by se pacienti urazili, pokud se zept\u00e1te na jejich n\u00e1vyky spojen\u00e9 s pit\u00edm.<\/li>\n<li>Ptejte se \u201ejak\u201c a \u201epro\u010d\u201c pacienti pij\u00ed, sp\u00ed\u0161e ne\u017e pouze \u201ekolik\u201c pij\u00ed. Pochopen\u00edm soci\u00e1ln\u00edch a kulturn\u00edch hodnot, kter\u00e9 formuj\u00ed pit\u00ed pacient\u016f, zv\u00fd\u0161\u00edte \u00fa\u010dinnost poskytovan\u00fdch rad.<\/li>\n<li>Pomozte pacient\u016fm vyvinout preventivn\u00ed strategie zam\u011b\u0159en\u00e9 na konkr\u00e9tn\u00ed rizikov\u00e9 okam\u017eiky podle toho, co v\u00e1m \u0159eknou o situac\u00edch, ve kter\u00fdch s nejv\u011bt\u0161\u00ed pravd\u011bpodobnost\u00ed hodn\u011b pij\u00ed. Pokud je to mo\u017en\u00e9, vytvo\u0159te tyto strategie podle toho, co mnoho jin\u00fdch pacient\u016f pova\u017eovalo za provediteln\u00e9 a efektivn\u00ed postupy. P\u0159\u00edkladem m\u016f\u017ee b\u00fdt omezen\u00ed pit\u00ed v konkr\u00e9tn\u00edch prost\u0159ed\u00edch, nap\u0159\u00edklad doma nebo s ur\u010dit\u00fdmi soci\u00e1ln\u00edmi skupinami, jako jsou d\u011bti.<\/li>\n<li>A kone\u010dn\u011b, vzhledem k tomu, \u017ee \u010das u l\u00e9ka\u0159e je v\u017edy omezen\u00fd, zam\u011b\u0159te se na poskytnut\u00ed kr\u00e1tk\u00fdch doporu\u010den\u00ed ohledn\u011b alkoholu u pacient\u016f, jejich\u017e zdravotn\u00ed stav jako je vysok\u00fd krevn\u00ed tlak, du\u0161evn\u00ed zdrav\u00ed nebo \u017ealude\u010dn\u00ed pot\u00ed\u017ee m\u016f\u017ee m\u00edt souvislost s nadm\u011brn\u00fdm pit\u00edm. Zam\u011b\u0159it se na vyu\u017eit\u00ed vz\u00e1cn\u00fdch zdroj\u016f m\u016f\u017ee b\u00fdt p\u0159ijateln\u011bj\u0161\u00ed a poutav\u011bj\u0161\u00ed i pro samotn\u00e9 pacienty.<\/li>\n<\/ul>\n<p>P\u0159elo\u017eila: Renata Hacklov\u00e1<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Amy O\u2019Donnell, Newcastle University, UK Levels of drinking have fallen recently in some parts of Europe, particularly amongst young people. However, excessive alcohol consumption remains a major risk factor for poor health and early death. Providing simple brief advice [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1830,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[32,25,9,13,16],"tags":[],"class_list":["post-1803","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assessment","category-goal-setting","category-habit","category-interventions","category-planning"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"cz","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","fi","sv","tr","uk"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":true,"content":true,"excerpt":false},"my":{"title":true,"content":true,"excerpt":false},"bg":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false},"hr":{"title":true,"content":true,"excerpt":false},"cz":{"title":true,"content":true,"excerpt":false},"da":{"title":true,"content":true,"excerpt":false},"de":{"title":true,"content":true,"excerpt":false},"es":{"title":true,"content":true,"excerpt":false},"fr":{"title":true,"content":true,"excerpt":false},"gr":{"title":true,"content":true,"excerpt":false},"he":{"title":true,"content":true,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":true,"content":true,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":true,"content":true,"excerpt":false},"lt":{"title":false,"content":false,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":true,"content":true,"excerpt":false},"no":{"title":true,"content":true,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":true,"content":true,"excerpt":false},"ro":{"title":true,"content":true,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":true,"content":true,"excerpt":false},"fi":{"title":true,"content":true,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":true,"content":true,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false}}},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/1803","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/comments?post=1803"}],"version-history":[{"count":22,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/1803\/revisions"}],"predecessor-version":[{"id":4583,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/posts\/1803\/revisions\/4583"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/media\/1830"}],"wp:attachment":[{"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/media?parent=1803"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/categories?post=1803"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/cz\/wp-json\/wp\/v2\/tags?post=1803"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}