{"id":5016,"date":"2026-06-21T23:58:33","date_gmt":"2026-06-21T23:58:33","guid":{"rendered":"https:\/\/practicalhealthpsychology.com\/?post_type=module&p=5016"},"modified":"2026-09-11T09:06:28","modified_gmt":"2026-09-11T09:06:28","slug":"module-2","status":"publish","type":"module","link":"https:\/\/practicalhealthpsychology.com\/sk\/module\/module-2\/","title":{"rendered":"V\u010dasn\u00fd z\u00e1sah, lep\u0161ie v\u00fdsledky: V\u00fdznam r\u00fdchlej intervencie pri COVID-19 u vysokorizikov\u00fdch pacientov"},"content":{"rendered":"

Autori: \u0130rem Berna G\u00fcven\u00e7 Erdo\u011fan, Middle East Technical University, Turecko; Iga Palacz-Poborczyk, SWPS University, Po\u013esko; Olga Perski, Stockholm University, \u0160v\u00e9dsko; Sheson Tiwari, Psyfolks Education, India; Belgin \u00dcnal, University of Michigan, USA\u00a0<\/strong><\/p>\n

Progresia COVID-19 a v\u00fdznam v\u010dasn\u00e9ho nasadenia lie\u010dby<\/b><\/p>\n

V\u00e4\u010d\u0161ina \u013eud\u00ed sa z COVID-19 zotav\u00ed a\u00a0nepotrebuje intenz\u00edvnu lie\u010dbu. V\u00e4\u010d\u0161inou posta\u010duje podporn\u00e1 starostlivos\u0165 a symptomatick\u00e1 lie\u010dba. \u010cas\u0165 popul\u00e1cie \u2013 najm\u00e4 star\u0161\u00ed dospel\u00ed, nezao\u010dkovan\u00e9 osoby a \u013eudia s chronick\u00fdmi ochoreniami \u2013 v\u0161ak \u010del\u00ed vy\u0161\u0161iemu riziku z\u00e1va\u017en\u00e9ho priebehu ochorenia. <\/span>Svetov\u00e1 zdravotn\u00edcka organiz\u00e1cia<\/span><\/a> (World Health Organization, WHO) preto zd\u00f4raz\u0148uje v\u00fdznam v\u010dasnej lie\u010dby u t\u00fdchto vysokorizikov\u00fdch skup\u00edn s cie\u013eom predch\u00e1dza\u0165 hospitaliz\u00e1ci\u00e1m, intenz\u00edvnej starostlivosti alebo \u00famrtiam.<\/span><\/p>\n

U niektor\u00fdch pacientov sa odpor\u00fa\u010da lie\u010dba antivirotikami, ktor\u00e1 m\u00f4\u017ee v\u00fdrazne zn\u00ed\u017ei\u0165 riziko kritick\u00e9ho priebehu ochorenia, pri\u010dom naj\u00fa\u010dinnej\u0161ia je vtedy, ak sa za\u010dne po\u010das prv\u00fdch piatich dn\u00ed od objavenia pr\u00edznakov. Oneskorenie testovania, diagnostiky alebo za\u010diatku lie\u010dby m\u00f4\u017ee v\u00fdznamne zn\u00ed\u017ei\u0165 \u00fa\u010dinnos\u0165 dostupnej lie\u010dby. Zabezpe\u010denie r\u00fdchleho pr\u00edstupu k zdravotnej starostlivosti, najm\u00e4 v komunitnom prostred\u00ed, je preto k\u013e\u00fa\u010dov\u00e9 pre maximaliz\u00e1ciu pr\u00ednosu lie\u010dby a\u00a0lep\u0161iu lie\u010dbu pacientov.<\/span><\/p>\n

Kontextovo \u0161pecifick\u00e9 d\u00f4kazy podporuj\u00face skor\u00fa lie\u010dbu pri zni\u017eovan\u00ed hospitaliz\u00e1ci\u00ed a \u00famrtnosti<\/b><\/p>\n

V\u010dasn\u00e1 lie\u010dba v\u00fdrazne zni\u017euje riziko hospitaliz\u00e1cie a \u00famrtia, najm\u00e4 u pacientov s vysok\u00fdm rizikom z\u00e1va\u017en\u00e9ho priebehu ochorenia. Ak chceme pochopi\u0165 naliehavos\u0165, potrebujeme d\u00f4kazy interpretova\u0165 v konkr\u00e9tnom klinickom a popula\u010dnom kontexte.<\/span><\/p>\n

Rozsiahla randomizovan\u00e1 klinick\u00e1 \u0161t\u00fadia<\/span><\/a> realizovan\u00e1 vo viacer\u00fdch krajin\u00e1ch vr\u00e1tane USA, Braz\u00edlie, Ju\u017enej Afriky, Indie a Mexika uk\u00e1zala, \u017ee nehospitalizovan\u00ed nezao\u010dkovan\u00ed vysokorizikov\u00ed dospel\u00ed, ktor\u00ed dostali lie\u010dbu antivirotikami po\u010das prv\u00fdch troch dn\u00ed od objavenia sympt\u00f3mov, takmer o 89 % ni\u017e\u0161iu pravdepodobnos\u0165 hospitaliz\u00e1cie alebo \u00famrtia v porovnan\u00ed s placebom.<\/span><\/p>\n

R\u00fdchla lie\u010dba pr\u00edpravkom sotrovimab, teda cielenou protil\u00e1tkovou lie\u010dbou, <\/span>podobne zn\u00ed\u017eila riziko<\/span><\/a> progresie ochorenia o 85 % (v \u010dase skor\u0161\u00edch variantov v\u00edrusu; \u00fa\u010dinnos\u0165 sa pri neskor\u0161\u00edch variantoch menila). Tieto zistenia zd\u00f4raz\u0148uj\u00fa v\u00fdznam v\u010dasnej intervencie u vysokorizikov\u00fdch os\u00f4b vr\u00e1tane star\u0161\u00edch pacientov a \u013eud\u00ed s ochoreniami ako s\u00fa obezita alebo diabetes. V\u00fdznamn\u00e9 je aj to, \u017ee viac ne\u017e 60 % \u00fa\u010dastn\u00edkov poch\u00e1dzalo z hisp\u00e1nskych a latinskoamerick\u00fdch komun\u00edt, ktor\u00e9 boli pand\u00e9miou ne\u00famerne zasiahnut\u00e9, \u010do nazna\u010duje \u00fa\u010dinnos\u0165 v\u010dasnej lie\u010dby naprie\u010d r\u00f4znymi soci\u00e1lno-demografick\u00fdmi skupinami.<\/span><\/p>\n

Systematick\u00fd preh\u013ead 18 \u0161t\u00fadi\u00ed v\u00a0prirodzenom prostred\u00ed<\/span><\/a> z viacer\u00fdch kraj\u00edn rovnako uk\u00e1zal, \u017ee r\u00fdchla lie\u010dba v\u00fdznamne zni\u017eovala hospitaliz\u00e1ciu a mortalitu a \u017ee najv\u00e4\u010d\u0161\u00ed pr\u00ednos sa dosiahol pri za\u010dat\u00ed lie\u010dby do piatich dn\u00ed od n\u00e1stupu sympt\u00f3mov. <\/span>Ve\u013ek\u00e1 \u0161t\u00fadia z Hongkongu<\/span><\/a> sleduj\u00faca viac ne\u017e 87 000 pacientov zistila, \u017ee za\u010diatok lie\u010dby po\u010das prv\u00fdch 1\u20132 dn\u00ed od objavenia sympt\u00f3mov v\u00fdznamne zni\u017eoval potrebu hospitaliz\u00e1cie aj mortalitu v porovnan\u00ed s neskor\u0161\u00edm nasaden\u00edm lie\u010dby. Tento vzorec konzistentne fungoval naprie\u010d demografick\u00fdmi a klinick\u00fdmi podskupinami vr\u00e1tane veku, pohlavia a vakcina\u010dn\u00e9ho statusu. Spolo\u010dne tieto d\u00f4kazy podporuj\u00fa jednoduch\u00fd, no z\u00e1sadn\u00fd z\u00e1ver: skor\u00e1 lie\u010dba funguje a oneskorenie zni\u017euje jej \u00fa\u010dinnos\u0165.<\/span><\/p>\n

Preh\u013ead odpor\u00fa\u010danej lie\u010dby v s\u00falade s lok\u00e1lnymi klinick\u00fdmi odpor\u00fa\u010daniami<\/b><\/p>\n

Ak vieme, \u017ee na\u010dasovanie lie\u010dby je rozhoduj\u00face, ak\u00e9 formy lie\u010dby s\u00fa vlastne dostupn\u00e9 a komu by mali by\u0165 podan\u00e9?<\/span><\/p>\n

U nehospitalizovan\u00fdch dospel\u00fdch s miernym a\u017e stredne z\u00e1va\u017en\u00fdm COVID-19 je naj\u00fa\u010dinnej\u0161ia antivir\u00e1lna lie\u010dba. <\/span>V s\u00fa\u010dasnosti sa pri lie\u010dbe COVID-19 naj\u010dastej\u0161ie pou\u017e\u00edvaj\u00fa tri hlavn\u00e9 antivirotik\u00e1<\/span><\/a>: remdesivir, nirmatrelvir\/ritonavir a molnupiravir. Spr\u00e1vna vo\u013eba z\u00e1vis\u00ed od individu\u00e1lneho rizikov\u00e9ho profilu pacienta, u\u017e\u00edvan\u00fdch liekov, sp\u00f4sobu podania a lok\u00e1lnej dostupnosti.<\/span><\/p>\n

Remdesivir sa pod\u00e1va formou trojd\u0148ovej intraven\u00f3znej inf\u00fazie a uprednost\u0148uje sa v pr\u00edpadoch, ke\u010f peror\u00e1lna lie\u010dba nie je vhodn\u00e1. <\/span>Randomizovan\u00e1 kontrolovan\u00e1 \u0161t\u00fadia<\/span><\/a> uk\u00e1zala, \u017ee trojd\u0148ov\u00e1 ambulantn\u00e1 lie\u010dba remdesivirom v\u00fdznamne zn\u00ed\u017eila mieru hospitaliz\u00e1ci\u00ed a \u00famrtnos\u0165 v porovnan\u00ed s placebom. Remdesivir sa <\/span>odpor\u00fa\u010da<\/span><\/a> pri hospitalizovan\u00fdch pacientoch s COVID-19 spolu s imunomodula\u010dnou lie\u010dbou pri potrebe oxygenoterapie a predstavuje druh\u00fa lie\u010debn\u00fa mo\u017enos\u0165 pri vysokorizikov\u00fdch ambulantn\u00fdch pacientoch, ak nirmatrelvir\/ritonavir nie je vhodn\u00fd.<\/span><\/p>\n

Nirmatrelvir\/ritonavir (Paxlovid) sa u\u017e\u00edva peror\u00e1lne, zvy\u010dajne po\u010das piatich dn\u00ed, a <\/span>preuk\u00e1zalo sa<\/span><\/a>, \u017ee v\u00fdznamne zni\u017euje riziko hospitaliz\u00e1cie a \u00famrtia u vysokorizikov\u00fdch nezao\u010dkovan\u00fdch os\u00f4b. <\/span>WHO<\/span><\/a> odpor\u00fa\u010da nirmatrelvir\/ritonavir ako lie\u010dbu prvej l\u00ednie pre vysokorizikov\u00fdch nehospitalizovan\u00fdch pacientov.<\/span><\/p>\n

Do tretice, molnupiravir sa taktie\u017e u\u017e\u00edva peror\u00e1lne a pova\u017euje sa za lie\u010dbu tretej l\u00ednie a <\/span>odpor\u00fa\u010da<\/span><\/a> sa pacientom, ktor\u00ed nem\u00f4\u017eu vyu\u017e\u00edva\u0165 alebo tolerova\u0165 predch\u00e1dzaj\u00face mo\u017enosti lie\u010dby. <\/span>Randomizovan\u00e1 kontrolovan\u00e1 \u0161t\u00fadia<\/span><\/a> preuk\u00e1zala v\u00fdznamn\u00e9 zn\u00ed\u017eenie miery hospitaliz\u00e1ci\u00ed a \u00famrtnosti u nezao\u010dkovan\u00fdch dospel\u00fdch, hoci d\u00f4kazy u zao\u010dkovan\u00fdch popul\u00e1ci\u00ed boli <\/span>menej konzistentn\u00e9<\/span><\/a>, nazna\u010duj\u00fa sk\u00f4r miernej\u0161\u00ed efekt.<\/span><\/p>\n

Dostupnos\u0165 jednotliv\u00fdch terapi\u00ed sa m\u00f4\u017ee l\u00ed\u0161i\u0165 v z\u00e1vislosti od zdravotn\u00edckeho syst\u00e9mu a dostupn\u00fdch zdrojov. Pri v\u0161etk\u00fdch troch liekoch je rozhoduj\u00face na\u010dasovanie, ke\u010f\u017ee v\u0161etky vykazuj\u00fa vy\u0161\u0161iu \u00fa\u010dinnos\u0165 v skor\u00fdch \u0161t\u00e1di\u00e1ch ochorenia. Oneskorenie testovania, diagnostiky alebo predpisu lie\u010dby priamo zni\u017euje pravdepodobnos\u0165 priazniv\u00e9ho \u00fa\u010dinku.<\/span><\/p>\n

Komunika\u010dn\u00e9 strat\u00e9gie na prekon\u00e1vanie v\u00e1hania s lie\u010dbou<\/b><\/p>\n

Pre\u010do v\u00e1hanie s lie\u010dbou pretrv\u00e1va, aj ke\u010f s\u00fa klinick\u00e9 argumenty a pr\u00ednosy lie\u010dby jasn\u00e9?<\/b><\/p>\n

K oneskoreniu rozhodovania prispieva viacero faktorov. \u010castou bari\u00e9rou je pr\u00edstup \u201e<\/span>po\u010dk\u00e1me a uvid\u00edme<\/span><\/a>\u201c, pri ktorom pacienti podce\u0148uj\u00fa z\u00e1va\u017enos\u0165 COVID-19 a odkladaj\u00fa lie\u010dbu. \u010cast\u00e9 s\u00fa aj obavy z ne\u017eiaducich \u00fa\u010dinkov a liekov\u00fdch interakci\u00ed, najm\u00e4 u pacientov u\u017e\u00edvaj\u00facich viacero liekov.<\/span><\/p>\n

\u010eal\u0161\u00edm probl\u00e9mom je obmedzen\u00e9 povedomie a s\u0165a\u017een\u00fd pr\u00edstup k jasn\u00fdm inform\u00e1ci\u00e1m. V\u00fdskumy ukazuj\u00fa, \u017ee <\/span>iba pribli\u017ene 54 % dospel\u00fdch po\u010dulo o\u00a0liekoch ako je Paxlovid<\/span><\/a> (nirmatrelvir\/ritonavir) pred svojou diagn\u00f3zou. Tieto faktory spolo\u010dne vytv\u00e1raj\u00fa neistotu, ktor\u00e1 vedie pacientov k v\u00e1haniu alebo odkladaniu lie\u010dby.<\/span><\/p>\n

\u010co mo\u017eno v praxi robi\u0165 inak?<\/b><\/p>\n

V prvom rade je potrebn\u00e9 zd\u00f4razni\u0165, \u017ee lie\u010dbou ochorenia COVID-19 je <\/span>\u010dasovo senzit\u00edvna prevent\u00edvna intervencia<\/b>, nielen zmier\u0148ovanie sympt\u00f3mov. <\/span>Antivirotik\u00e1 by sme mali prezentova\u0165 ako strat\u00e9giu prevencie z\u00e1va\u017en\u00e9ho priebehu ochorenia<\/span><\/a>, aby pacienti pochopili, \u017ee skor\u00e1 lie\u010dba zni\u017euje riziko hospitaliz\u00e1cie a v\u00e1\u017eneho ochorenia.<\/span><\/p>\n

V\u00a0druhom rade je d\u00f4le\u017eit\u00e9 <\/span>priame odpor\u00fa\u010danie od d\u00f4veryhodn\u00e9ho poskytovate\u013ea zdravotnej starostlivosti<\/b>. Existuje v\u00fdrazne vy\u0161\u0161ia pravdepodobnos\u0165, \u017ee pacienti prijm\u00fa lie\u010dbu, ak im ju jednozna\u010dne odpor\u00fa\u010da lek\u00e1r alebo lek\u00e1rka, ktor\u00e9ho poznaj\u00fa, a\u00a0uist\u00ed ich o\u00a0bezpe\u010dnosti a kompatibilite s\u00a0liekmi, ktor\u00e9 u\u017e\u00edvaj\u00fa. D\u00e1ta ukazuj\u00fa, \u017ee po\u010det \u013eud\u00ed ochotn\u00fdch u\u017e\u00edva\u0165 antivirotik\u00e1 <\/span>st\u00fapne o viac ne\u017e 20 %, ak ich odporu\u010d\u00ed ich lek\u00e1r, pri\u010dom u dospel\u00fdch nad 65 rokov m\u00f4\u017ee dosiahnu\u0165 a\u017e 93 %.<\/span><\/a><\/p>\n

Napokon, z\u00e1sadn\u00fd v\u00fdznam m\u00e1 <\/span>proakt\u00edvne oslovovanie pacientov a \u0161tandardizovan\u00e1 eduk\u00e1cia<\/b>. Pacienti len zriedkavo \u017eiadaj\u00fa lie\u010dbu sami od seba \u2013 \u0161t\u00fadie ukazuj\u00fa, \u017ee <\/span>menej ne\u017e 20 % vhodn\u00fdch pacientov je dostato\u010dne informovan\u00fdch a z\u00e1rove\u0148 iniciat\u00edvnych na to, aby si lie\u010dbu sami akt\u00edvne vy\u017eiadali<\/span><\/a>. Zdravotn\u00edcke t\u00edmy by preto mali <\/span>vhodn\u00fdch pacientov kontaktova\u0165 \u010do najr\u00fdchlej\u0161ie<\/span><\/a> po diagnostikovan\u00ed a poskytn\u00fa\u0165 im stru\u010dn\u00e9 a \u0161trukt\u00farovan\u00e9 inform\u00e1cie o pr\u00ednosoch, rizik\u00e1ch a \u010fal\u0161om postupe.<\/span><\/p>\n

K\u013e\u00fa\u010dov\u00e9 posolstv\u00e1<\/b><\/p>\n

Skor\u00e1 lie\u010dba COVID-19 po\u010das prv\u00fdch piatich dn\u00ed od objavenia sympt\u00f3mov je pre vysokorizikov\u00fdch pacientov z\u00e1sadn\u00e1, preto\u017ee m\u00f4\u017ee dramaticky zn\u00ed\u017ei\u0165 riziko hospitaliz\u00e1cie a \u00famrtia. Jej \u00fa\u010dinnos\u0165 podporuj\u00fa siln\u00e9 d\u00f4kazy z klinick\u00fdch \u0161t\u00fadi\u00ed aj re\u00e1lnej praxe. Antivirotik\u00e1 ako nirmatrelvir\/ritonavir, remdesivir a molnupiravir prin\u00e1\u0161aj\u00fa najv\u00e4\u010d\u0161\u00ed benefit pri skorom podan\u00ed, pri\u010dom v\u00fdber lie\u010dby z\u00e1vis\u00ed od charakterist\u00edk pacienta a dostupnosti liekov. Napriek jasn\u00fdm benefitom sa v\u0161ak st\u00e1le stret\u00e1vame s oneskoren\u00edm lie\u010dby z\u00a0d\u00f4vodu n\u00edzkeho povedomia a v\u00e1hania. V\u010dasn\u00e9 odpor\u00fa\u010dania zo strany pracovn\u00edkov zdravotn\u00edckych zariaden\u00ed, proakt\u00edvne oslovovanie pacientov a prezentovanie antivirot\u00edk ako prevent\u00edvnej intervencie s\u00fa z\u00e1kladom lep\u0161ej lie\u010dby a\u00a0lep\u0161\u00edch v\u00fdsledkov.<\/span><\/p>\n

Praktick\u00e9 odpor\u00fa\u010dania<\/b><\/p>\n

    \n
  1. Uprednostnite skor\u00fd z\u00e1sah<\/b>
    \n<\/span>Antivirotik\u00e1 s\u00fa naj\u00fa\u010dinnej\u0161ie po\u010das prv\u00fdch piatich dn\u00ed od objavenia sympt\u00f3mov. Ne\u010dakajte, k\u00fdm sa stav pacienta zhor\u0161\u00ed. Odpor\u00fa\u010dajte vysokorizikov\u00fdm pacientom, aby mali doma k\u00a0dispoz\u00edcii testy a vedeli, \u017ee maj\u00fa kontaktova\u0165 zdravotn\u00edcke zariadenie okam\u017eite v prv\u00fd de\u0148 pozit\u00edvneho v\u00fdsledku.<\/span><\/li>\n
  2. Zamerajte sa na zranite\u013en\u00fdch pacientov<\/b>
    \n<\/span>Venujte zv\u00fd\u0161en\u00fa pozornos\u0165 dospel\u00fdm s diabetom, srdcovocievnymi ochoreniami, chronick\u00fdm ochoren\u00edm obli\u010diek alebo BMI nad 30. T\u00edto pacienti sa spo\u010diatku \u010dasto c\u00edtia \u201ev poriadku\u201c, no z\u00e1rove\u0148 \u010delia vysok\u00e9mu riziku n\u00e1hleho zhor\u0161enia zdravotn\u00e9ho stavu.<\/span><\/li>\n
  3. Identifikujte a skr\u00ednujte pacientov v\u010das<\/b>
    \n<\/span>Proakt\u00edvne identifikujte pacientov s najvy\u0161\u0161\u00edm rizikom a nastavte jasn\u00fd \u201ezr\u00fdchlen\u00fd\u201c postup pre skor\u00fa diagnostiku hne\u010f po objaven\u00ed sympt\u00f3mov. V\u010dasn\u00e1 identifik\u00e1cia vhodn\u00fdch pacientov je z\u00e1kladom prevencie klinick\u00e9ho zhor\u0161enia.<\/span><\/li>\n
  4. Prezentujte lie\u010dbu ako prevenciu<\/b>
    \n<\/span>Ak sa pacient aktu\u00e1lne c\u00edti dobre, m\u00f4\u017ee lie\u010dbu vn\u00edma\u0165 ako zbyto\u010dn\u00fa. Vysvetlite im, \u017ee cie\u013eom nie je len lie\u010di\u0165 ka\u0161e\u013e, ale pred\u00eds\u0165 hospitaliz\u00e1cii o nieko\u013eko dn\u00ed. Predstava dom\u00e1cej lie\u010dby namiesto pobytu v nemocnici m\u00f4\u017ee by\u0165 siln\u00fdm motiva\u010dn\u00fdm faktorom.<\/span><\/li>\n
  5. Minimalizujte oneskorenia pri predpisovan\u00ed lie\u010dby<\/b>
    \n<\/span>\u010co najsk\u00f4r skontrolujte aktu\u00e1lne u\u017e\u00edvan\u00e9 lieky, kontraindik\u00e1cie a vhodnos\u0165 lie\u010dby. Jednoduch\u00e9 postupy predpisovania liekov a\u00a0r\u00fdchle zos\u00faladenie liekovej lie\u010dby m\u00f4\u017eu pom\u00f4c\u0165 vysokorizikov\u00fdm pacientom za\u010da\u0165 lie\u010dbu antivirotikami dostato\u010dne r\u00fdchlo a\u00a0v\u010das vo vhodnom terapeutickom okne.<\/span><\/li>\n<\/ol>\n

    Prelo\u017eil: Radom\u00edr Masaryk<\/b><\/p>\n

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