{"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\/sk\/2020\/11\/improving-the-delivery-of-brief-alcohol-advice-in-primary-care-views-from-both-sides-of-the-consultation-table\/","title":{"rendered":"Zlep\u0161enie poskytovania kr\u00e1tkych odpor\u00fa\u010dan\u00ed t\u00fdkaj\u00facich sa alkoholu v prim\u00e1rnej starostlivosti: poh\u013eady z oboch str\u00e1n konzulta\u010dn\u00e9ho stola"},"content":{"rendered":"<p><strong>Amy O\u2019Donnell, Newcastle University, Ve\u013ek\u00e1 Brit\u00e1nia<\/strong><\/p>\n<p>V niektor\u00fdch \u010dastiach Eur\u00f3py ned\u00e1vno poklesla \u00farove\u0148 pitia, najm\u00e4 medzi <a href=\"https:\/\/www.sheffield.ac.uk\/polopoly_fs\/1.806889!\/file\/Oldham_Holmes_Youth_drinking_in_decline_FINAL.pdf\">mlad\u00fdmi \u013eu\u010fmi<\/a>. Nadmern\u00e1 konzum\u00e1cia alkoholu v\u0161ak zost\u00e1va hlavn\u00fdm rizikov\u00fdm faktorom pre zl\u00e9 zdravie a pred\u010dasn\u00fa smr\u0165. Poskytovanie jednoduch\u00fdch kr\u00e1tkych r\u00e1d osob\u00e1m identifikovan\u00fdm ako siln\u00ed u\u017e\u00edvatelia alkoholu <a href=\"https:\/\/www.cochranelibrary.com\/cdsr\/doi\/10.1002\/14651858.CD004148.pub4\/full\">m\u00f4\u017ee pom\u00f4c\u0165 zn\u00ed\u017ei\u0165 mno\u017estvo alkoholu, ktor\u00e9 \u013eudia konzumuj\u00fa<\/a>, najm\u00e4 ak s\u00fa poskytovan\u00e9 lek\u00e1rmi prim\u00e1rnej starostlivosti, ako s\u00fa praktick\u00ed lek\u00e1ri alebo zdravotn\u00e9 sestry. <a href=\"http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0006\/351294\/Alcohol-training-manual-final-edit-LSJB-290917-new-cover.pdf?ua=1\">Stru\u010dn\u00e1 rada t\u00fdkaj\u00faca sa alkoholu<\/a> zah\u0155\u0148a kr\u00e1tky \u0161trukt\u00farovan\u00fd rozhovor, ktor\u00e9ho cie\u013eom je motivova\u0165 a podporova\u0165 pacienta, aby zv\u00e1\u017eil zmenu v pit\u00ed alkoholu a zn\u00ed\u017eil tak riziko ujmy u\u00a0svojej osoby. St\u00e1le sme \u00faplne neidentifikovali k\u013e\u00fa\u010dov\u00e9 zlo\u017eky t\u00fdchto rozhovorov, ale <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/j.1360-0443.2012.03845.x\">osobitne \u00fa\u010dinnou s\u00fa\u010das\u0165ou bal\u00edka<\/a> sa jav\u00ed poskytovanie osobnej sp\u00e4tnej v\u00e4zby o konzum\u00e1cii alkoholu pacientom a podpora jeho sebakontroly.<\/p>\n<p><!--more--><\/p>\n<p>Proces zav\u00e1dzania lie\u010dby a intervenci\u00ed do rutinnej zdravotnej starostlivosti zalo\u017een\u00fdch na d\u00f4kazoch je v\u0161ak pomal\u00e1 a zlo\u017eit\u00e1 z\u00e1le\u017eitos\u0165. Niektor\u00e9 odhady nazna\u010duj\u00fa, \u017ee k\u00fdm sa v\u00fdsledky v\u00fdskumu dostan\u00fa do ka\u017edodennej klinickej praxe, trv\u00e1 to v priemere <a href=\"https:\/\/journals.sagepub.com\/doi\/full\/10.1258\/jrsm.2011.110180#bibr-JRSM-11-0180C1\">17 rokov<\/a>. Po troch desa\u0165ro\u010diach v\u00fdskumu, viac ako 70 randomizovan\u00fdch kontrolovan\u00fdch \u0161t\u00fadi\u00e1ch a po\u010detn\u00fdch preh\u013eadoch publikovan\u00fdch \u0161t\u00fadi\u00ed sa stru\u010dn\u00e9 rady t\u00fdkaj\u00face sa alkoholu v glob\u00e1lnych syst\u00e9moch prim\u00e1rnej zdravotnej starostlivosti st\u00e1le be\u017ene neposkytuj\u00fa. Aby sme pochopili, pre\u010do nie je stru\u010dn\u00e1 rada t\u00fdkaj\u00faca sa alkoholu \u00faplne integrovan\u00e1 do prim\u00e1rnej starostlivosti, mus\u00edme zv\u00e1\u017ei\u0165 <a href=\"https:\/\/bmcpsychology.biomedcentral.com\/articles\/10.1186\/s40359-015-0089-9\">mnoho r\u00f4znych poh\u013eadov<\/a> na probl\u00e9m, vr\u00e1tane n\u00e1zorov t\u00fdch, ktor\u00ed poskytuj\u00fa zdravotn\u00fa starostlivos\u0165 (klinick\u00ed lek\u00e1ri), a t\u00fdch, ktor\u00ed ju vyu\u017e\u00edvaj\u00fa (pacientov).<\/p>\n<p>\u010co n\u00e1m teda \u013eudia, ktor\u00ed sa podie\u013eaj\u00fa na poskytovan\u00ed a prij\u00edman\u00ed stru\u010dn\u00fdch r\u00e1d t\u00fdkaj\u00facich sa alkoholu v prim\u00e1rnej starostlivosti, povedia o v\u00fdzvach, ktor\u00fdm \u010delia?<\/p>\n<p>Medzi be\u017en\u00e9 probl\u00e9my, ktor\u00e9 nastolili praktick\u00ed lek\u00e1ri a zdravotn\u00e9 sestry, patr\u00ed nedostatok \u010dasu, \u0161kolen\u00ed alebo finan\u010dn\u00fdch zdrojov na to, aby svojim pacientom mohli oh\u013eadne u\u017e\u00edvania alkoholu radi\u0165. Poskytovanie dodato\u010dn\u00fdch platieb praktick\u00fdm lek\u00e1rom za tento typ intervencie v\u0161ak nemus\u00ed by\u0165 nevyhnutne \u00fa\u010dinnou strat\u00e9giou implement\u00e1cie. Jedna ned\u00e1vna \u0161t\u00fadia zistila, \u017ee zavedenie finan\u010dn\u00fdch stimulov pre poradenstvo v oblasti alkoholu v anglickej prim\u00e1rnej starostlivosti nemalo takmer \u017eiadny vplyv na mieru realiz\u00e1cie v praxi. \u010eal\u0161\u00ed v\u00fdskum nazna\u010duje, \u017ee postoje a presved\u010denia lek\u00e1rov o relevantnosti, citlivosti a celkovej hodnote rozhovorov o alkohole pri be\u017en\u00fdch konzult\u00e1ci\u00e1ch s pacientom by mohli hra\u0165 v\u00e4\u010d\u0161iu \u00falohu pri ovplyv\u0148ovan\u00ed ich praxe. Niektor\u00ed praktick\u00ed lek\u00e1ri napr\u00edklad pochybuj\u00fa o tom, \u017ee ich pacienti bud\u00fa vn\u00edmav\u00ed k rad\u00e1m o zmene spr\u00e1vania pri pit\u00ed alkoholu, najm\u00e4 u t\u00fdch, ktor\u00ed pij\u00fa nadmerne. Je to \u010diasto\u010dne sp\u00f4soben\u00e9 ned\u00f4verou v \u00fa\u010dinnos\u0165 psychologick\u00fdch terapi\u00ed pri nadmernom po\u017e\u00edvan\u00ed alkoholu, ale je to tie\u017e preto, \u017ee praktick\u00ed lek\u00e1ri sa ob\u00e1vaj\u00fa, \u017ee by mohli pacientov urazi\u0165 nastolen\u00edm t\u00e9my konzum\u00e1cie alkoholu.<\/p>\n<p>Menej v\u00fdskumov sk\u00famalo perspekt\u00edvy pacientov v t\u00fdchto ot\u00e1zkach. Existuj\u00face \u0161t\u00fadie uv\u00e1dzaj\u00fa, \u017ee v\u00e4\u010d\u0161ina \u013eud\u00ed si mysl\u00ed, \u017ee je prijate\u013en\u00e9, aby sa praktick\u00ed lek\u00e1ri alebo zdravotn\u00e9 sestry p\u00fdtali na ich konzum\u00e1ciu alkoholu a pova\u017euj\u00fa tieto rady o \u017eivotnom \u0161t\u00fdle za cenn\u00fa s\u00fa\u010das\u0165 zdravotnej starostlivosti, najm\u00e4 u os\u00f4b so zdravotn\u00fdm stavom s\u00favisiacim s alkoholom. Rovnako ako niektor\u00ed lek\u00e1ri, aj pacienti si s\u00fa menej ist\u00ed, \u017ee by t\u00ed, ktor\u00ed konzumuj\u00fa alkohol nadmerne, boli otvoren\u00ed tomu hovori\u0165 o svojej konzum\u00e1cii alkoholu s praktick\u00fdmi lek\u00e1rmi, <a href=\"https:\/\/link.springer.com\/article\/10.1186\/s12889-018-5275-2\">aspo\u0148 nie pravdivo<\/a>. V\u00e4\u010d\u0161ou v\u00fdzvou v\u0161ak je, \u017ee mnoho pacientov vykazuje obmedzen\u00e9 povedomie o svojej vlastnej \u00farovni pitia. Je to \u010diasto\u010dne preto, \u017ee vypo\u010d\u00edta\u0165, ko\u013eko alkoholu je v skuto\u010dnosti v tom poh\u00e1ri v\u00edna alebo ginu a toniku, je dos\u0165 \u0165a\u017ek\u00e9 a m\u00f4\u017ee by\u0165 \u013eahk\u00e9 strati\u0165 preh\u013ead, ke\u010f si n\u00e1poje nalievate doma.<\/p>\n<p>Je to v\u0161ak aj preto, \u017ee mnoho z n\u00e1s sa pri konzum\u00e1cii alkoholu nepozer\u00e1 na to, ako ve\u013emi u n\u00e1s zvy\u0161uje riziko konkr\u00e9tnych chor\u00f4b (tj. na sp\u00f4sob, ak\u00fdm pitie vidia lek\u00e1ri, odborn\u00edci na verejn\u00e9 zdravie alebo epidemiol\u00f3govia), ale sk\u00f4r z h\u013eadiska \u00fastrednej \u00falohy, ktor\u00fa pre n\u00e1s zohr\u00e1va pri z\u00e1bave a oslav\u00e1ch. To znamen\u00e1, \u017ee niektor\u00ed pacienti by mohli by\u0165 neochotn\u00ed uzna\u0165, \u017ee pij\u00fa pr\u00edli\u0161 ve\u013ea, a\/alebo pochybova\u0165 o tom, pre\u010do ich poskytovate\u013e zdravotnej starostlivosti \u017eiada, aby obmedzili konzum\u00e1ciu. V s\u00favislosti s t\u00fdmto probl\u00e9mom n\u00e1m pacienti hovoria, \u017ee u\u017e uskuto\u010d\u0148uj\u00fa <a href=\"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-020-01142-9\">cel\u00fd rad strat\u00e9gi\u00ed<\/a> na obmedzenie pitia alkoholu, av\u0161ak zalo\u017een\u00fdch na \u201e\u017eivotn\u00fdch sk\u00fasenostiach\u201c z\u00edskan\u00fdch od vlastn\u00fdch rod\u00edn, priate\u013eov a soci\u00e1lnych skup\u00edn. Niektor\u00ed pacienti teda op\u00e4\u0165 vidia obmedzen\u00fd pr\u00ednos v rad\u00e1ch, ktor\u00e9 m\u00f4\u017eu pon\u00faka\u0165 praktick\u00ed lek\u00e1ri alebo zdravotn\u00e9 sestry v s\u00favislosti s pit\u00edm, a ktor\u00e9 sa z ich poh\u013eadu m\u00f4\u017eu javi\u0165 ako odpojen\u00e9 od skuto\u010dn\u00e9ho \u017eivota.<\/p>\n<p><strong>Praktick\u00e9 odpor\u00fa\u010dania<\/strong><\/p>\n<p>Ako teda m\u00f4\u017eeme v\u0161etky tieto n\u00e1zory, vn\u00edmanie a sk\u00fasenosti vyu\u017ei\u0165 na zlep\u0161enie implement\u00e1cie kr\u00e1tkych r\u00e1d o alkohole v prim\u00e1rnej zdravotnej starostlivosti?<\/p>\n<ul>\n<li>V prvom rade si m\u00f4\u017eete by\u0165 ist\u00ed, \u017ee je v poriadku p\u00fdta\u0165 sa svojich pacientov na ich pitie. Existuje len m\u00e1lo d\u00f4kazov, \u017ee by sa pacienti urazili, ak sa p\u00fdtate na ich n\u00e1vyky s\u00favisiace s konzum\u00e1ciou alkoholu.<\/li>\n<li>Nezabudnite sa op\u00fdta\u0165 ot\u00e1zky \u201eako\u201c a \u201epre\u010do\u201c pacienti skuto\u010dne pij\u00fa, a nie jednoducho \u201eko\u013eko\u201c. To zv\u00fd\u0161i relevantnos\u0165 a v\u00fdznam ka\u017edej rady, ktor\u00fa d\u00e1te, uznan\u00edm soci\u00e1lnych a kult\u00farnych hodn\u00f4t, ktor\u00e9 formuj\u00fa pitie pacientov.<\/li>\n<li>\u010ealej, na z\u00e1klade toho, \u010do v\u00e1m pacienti povedia o situ\u00e1ci\u00e1ch, v ktor\u00fdch s najv\u00e4\u010d\u0161ou pravdepodobnos\u0165ou pij\u00fa ve\u013ea, im pom\u00f4\u017ete vymyslie\u0165 prevent\u00edvne strat\u00e9gie zameran\u00e9 \u0161peci\u00e1lne na tieto kritick\u00e9 rizikov\u00e9 okamihy. Ak je to mo\u017en\u00e9, vybudujte tieto strat\u00e9gie taktike, ktor\u00fa pacienti pova\u017euj\u00fa za uskuto\u010dnite\u013en\u00fa a efekt\u00edvnu. Napr\u00edklad obmedzen\u00edm pitia v konkr\u00e9tnych prostrediach, napr\u00edklad doma, alebo v konkr\u00e9tnych soci\u00e1lnych skupin\u00e1ch, ako s\u00fa deti.<\/li>\n<li>A nakoniec, vzh\u013eadom na to, \u017ee \u010das s pacientom je v\u017edy obmedzen\u00fd, zamerajte sa na poskytovanie kr\u00e1tkych odpor\u00fa\u010dan\u00ed t\u00fdkaj\u00facich sa alkoholu pacientom, ktor\u00ed maj\u00fa \u0165a\u017ekosti, pri ktor\u00fdch existuje zjavn\u00e1 s\u00favislos\u0165 s nadmern\u00fdm pit\u00edm, ako s\u00fa vysok\u00fd krvn\u00fd tlak, du\u0161evn\u00e9 zdravie alebo \u017eal\u00fado\u010dn\u00e9 probl\u00e9my. Pom\u00f4\u017ee to lep\u0161ie vyu\u017ei\u0165 va\u0161e obmedzen\u00e9 kapacity a m\u00f4\u017ee to by\u0165 prijate\u013enej\u0161ie a p\u00fatavej\u0161ie pre samotn\u00fdch pacientov.<\/li>\n<\/ul>\n<p>[Prelo\u017eila Zuzana Dankulincov\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":"sk","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\/sk\/wp-json\/wp\/v2\/posts\/1803","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/comments?post=1803"}],"version-history":[{"count":22,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/posts\/1803\/revisions"}],"predecessor-version":[{"id":4583,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/posts\/1803\/revisions\/4583"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/media\/1830"}],"wp:attachment":[{"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/media?parent=1803"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/categories?post=1803"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/sk\/wp-json\/wp\/v2\/tags?post=1803"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}