{"id":43398,"date":"2023-11-03T08:07:31","date_gmt":"2023-11-03T07:07:31","guid":{"rendered":"https:\/\/www.invarena.cz\/?p=43398"},"modified":"2023-11-03T08:07:31","modified_gmt":"2023-11-03T07:07:31","slug":"nemocni-v-cesku-berou-prilis-mnoho-leku-a-ty-jim-pak-mohou-skodit","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=43398","title":{"rendered":"Nemocn\u00ed v\u00a0\u010cesku berou p\u0159\u00edli\u0161 mnoho l\u00e9k\u016f, a ty jim pak mohou \u0161kodit"},"content":{"rendered":"\n

\u010ce\u0161t\u00ed internist\u00e9 se sna\u017e\u00ed o zm\u011bnu \u2013 cht\u011bj\u00ed m\u00e9n\u011b zbyte\u010dn\u00fdch vy\u0161et\u0159en\u00ed<\/em><\/p>\n\n\n\n

\u010ce\u0161t\u00ed pacienti \u010dasto u\u017e\u00edvaj\u00ed zbyte\u010dn\u011b moc l\u00e9k\u016f, a ty jim pak mohou u\u0161kodit. Proch\u00e1zej\u00ed nav\u00edc \u0159adou vy\u0161et\u0159en\u00ed, kter\u00e1 jsou n\u011bkdy zbyte\u010dn\u00e1 nebo opakovan\u00e1 a zat\u011b\u017euj\u00ed jejich organismus. Zlep\u0161it sou\u010dasnou situaci cht\u011bj\u00ed \u010de\u0161t\u00ed internist\u00e9, kte\u0159\u00ed se p\u0159ipojili ke kampani Choosing Wisely (aneb Vyb\u00edrej moud\u0159e). Prvn\u00ed kroky a z\u00e1v\u011bry z\u00a0pr\u016fzkumu, jak to funguje v\u00a0\u010desk\u00fdch nemocnic\u00edch, kde je t\u0159eba zm\u011bn a jak zapojit pacienty p\u0159edstav\u00ed <\/strong>na sv\u00e9 nejv\u011bt\u0161\u00ed leto\u0161n\u00ed akci \u2013 XXX. kongresu \u010cesk\u00e9 internistick\u00e9 spole\u010dnosti, kter\u00fd startuje v\u00a0Brn\u011b 8. listopadu.<\/strong><\/p>\n\n\n\n

\u201eA\u017e 30 % n\u00e1klad\u016f sm\u011b\u0159uje na p\u00e9\u010di, kter\u00e1 p\u0159in\u00e1\u0161\u00ed pacientovi velmi mal\u00fd nebo \u017e\u00e1dn\u00fd u\u017eitek a m\u016f\u017ee mu i \u0161kodit. V\u00a0medic\u00edn\u011b plat\u00ed, \u017ee m\u00e9n\u011b je n\u011bkdy v\u00edce, ale praxe tomu neodpov\u00edd\u00e1. Na odd\u011blen\u00edch se b\u011b\u017en\u011b setk\u00e1v\u00e1me s\u00a0pacienty, kte\u0159\u00ed berou a\u017e deset l\u00e9k\u016f denn\u011b a proch\u00e1zej\u00ed \u0159adou vy\u0161et\u0159en\u00ed, kter\u00e1 maj\u00ed mal\u00fd diagnostick\u00fd p\u0159\u00ednos, nebo pacient\u016fm mohou dokonce ubl\u00ed\u017eit. L\u00e9ka\u0159i se \u010dasto neptaj\u00ed, jak\u00e9 l\u00e9ky vysadit, ale sp\u00ed\u0161e co je\u0161t\u011b nasadit. Mnohdy ze strachu, aby n\u011bco nepodcenili. Je obecn\u011b zn\u00e1m\u00e9, \u017ee pokud \u010dlov\u011bk u\u017e\u00edv\u00e1 v\u00edce ne\u017e p\u011bt l\u00e9k\u016f, stoup\u00e1 riziko ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f kv\u016fli jejich vz\u00e1jemn\u00e9mu ovliv\u0148ov\u00e1n\u00ed nad 30 %. A exponenci\u00e1ln\u011b stoup\u00e1 s\u00a0ka\u017ed\u00fdm dal\u0161\u00edm l\u00e9kem. Dle sv\u011btov\u00fdch dat jsou ne\u017e\u00e1douc\u00ed \u00fa\u010dinky l\u00e9\u010div\u00fdch p\u0159\u00edpravk\u016f p\u0159\u00ed\u010dinou a\u017e 10 % hospitalizac\u00ed,\u201c<\/em> vysv\u011btluje internista MUDr. Petr Grenar, kter\u00fd spole\u010dn\u011b s\u00a0kolegy provedl ve\u00a0FN Hradec Kr\u00e1lov\u00e9 pr\u016fzkum v\u00a0r\u00e1mci projektu Choosing Wisely. V\u00a0n\u011bm z\u00edskali odpov\u011bdi od n\u011bkolika des\u00edtek l\u00e9ka\u0159\u016f a odpov\u011bdi pak porovnali s\u00a0v\u00fdsledky\u00a0ankety sesb\u00edran\u00e9 americkou internistickou spole\u010dnost\u00ed p\u0159i inciativ\u011b Choosing Wisely. <\/p>\n\n\n\n

T\u00e9m\u011b\u0159 95 % dotazovan\u00fdch odpov\u011bd\u011blo, \u017ee n\u011bkter\u00e1 vy\u0161et\u0159en\u00ed se dle jejich n\u00e1zoru prov\u00e1d\u00ed nadbyte\u010dn\u011b. P\u0159edev\u0161\u00edm laboratorn\u00ed odb\u011bry, CT vy\u0161et\u0159en\u00ed nebo rentgen, ultrazvuk b\u0159icha, EKG \u010di magnetick\u00e1 rezonance. A t\u00e9m\u011b\u0159 77 % dotazovan\u00fdch soudilo, \u017ee se zbyte\u010dn\u011b p\u0159edepisuj\u00ed l\u00e9ky, a to nejv\u00edce antibiotika, antivirotika, l\u00e9ky na potla\u010den\u00ed produkce kyseliny v\u00a0\u017ealudku, hypnotika \u010di l\u00e9ky na bolest. <\/p>\n\n\n\n

Celkem 70,7 % l\u00e9ka\u0159\u016f p\u0159iznalo, \u017ee v\u00a0ka\u017edodenn\u00ed praxi prov\u00e1d\u011bj\u00ed \u00fakony, o jejich\u017e u\u017eite\u010dnosti pro pacienta nejsou p\u0159esv\u011bd\u010deni. \u201eL\u00e9ka\u0159i nej\u010dast\u011bji, jako d\u016fvod p\u0159edeps\u00e1n\u00ed zbytn\u00fdch vy\u0161et\u0159en\u00ed, uv\u00e1d\u011bli tlak okol\u00ed, respektive snahu o dodr\u017een\u00ed zab\u011bhl\u00e9 praxe. D\u00e1le pak strach z dopad\u016f, nal\u00e9h\u00e1n\u00ed pacienta nebo jeho rodiny.<\/em> V\u00fdsledky dotazn\u00edku se shoduj\u00ed se z\u00e1v\u011bry p\u016fvodn\u00ed ankety,\u201c<\/em> cituje MUDr. Grenar. P\u0159esn\u011b 82,5 % dotazovan\u00fdch l\u00e9ka\u0159\u016f by si z\u00e1rove\u0148 p\u0159\u00e1lo, aby jejich pacienti byli v\u00edce a podrobn\u011bji sezn\u00e1meni s\u00a0t\u00edm, co jim doporu\u010duj\u00ed za diagnostick\u00e9 a l\u00e9\u010debn\u00e9 kroky.<\/p>\n\n\n\n

Kter\u00e1 vy\u0161et\u0159en\u00ed byla nadbyte\u010dn\u00e1 a co pacient\u016fm sp\u00ed\u0161e u\u0161kodilo, ne\u017e pomohlo, budou nyn\u00ed zkoumat v pra\u017esk\u00e9 Thomayerov\u011b nemocnici, v\u00fdsledky budou zn\u00e1t p\u0159\u00ed\u0161t\u00ed rok. \u201eSestavili jsme tak\u00e9 let\u00e1ky pro pacienty, kter\u00e9 obsahuj\u00ed p\u011bt ot\u00e1zek, je\u017e by m\u011bli se sv\u00fdm l\u00e9ka\u0159em probrat. Tedy zda je dan\u00e9 vy\u0161et\u0159en\u00ed opravdu nutn\u00e9, jak\u00e1 z\u00a0n\u011bj plynou rizika, jestli jsou i jin\u00e9, jednodu\u0161\u0161\u00ed a bezpe\u010dn\u011bj\u0161\u00ed mo\u017enosti a co se stane, pokud neud\u011bl\u00e1 l\u00e9ka\u0159 nic. Tyto let\u00e1ky d\u00e1me k dispozici koleg\u016fm a budeme r\u00e1di, kdy\u017e se dostanou k\u00a0pacient\u016fm a\u0165 u\u017e v\u00a0ambulanc\u00edch, \u010di nemocnic\u00edch,\u201c<\/em> vysv\u011btluje internista z\u00a0Fakultn\u00ed Thomayerovy nemocnice v\u00a0Praze MUDr. Dan Raku\u0161an. <\/p>\n\n\n\n

Internist\u00e9, kte\u0159\u00ed u jednoho pacienta obvykle \u0159e\u0161\u00ed v\u00edce p\u0159\u00edtomn\u00fdch chorob najednou, se s \u201ep\u0159ed\u00e1vkov\u00e1n\u00edm\u201c l\u00e9ky, aneb tzv. polypragmazi\u00ed, setk\u00e1vaj\u00ed nej\u010dast\u011bji. Podle prof. MUDr. Jana V\u00e1clav\u00edka, Ph.D., FESC, FEFIM, p\u0159ednosty Intern\u00ed a kardiologick\u00e9 kliniky Fakultn\u00ed nemocnice Ostrava, jsou to pr\u00e1v\u011b oni, kdo se zam\u00fd\u0161l\u00ed nad celkov\u00fdm stavem nemocn\u00e9ho a nech\u00e1vaj\u00ed mu jen ty l\u00e9ky, kter\u00e9 jsou pro zlep\u0161en\u00ed jeho zdrav\u00ed z\u00e1sadn\u00ed.<\/p>\n\n\n\n

\u201eV\u00a0sou\u010dasnosti bohu\u017eel panuje p\u0159esv\u011bd\u010den\u00ed, \u017ee medic\u00edna je v\u0161emocn\u00e1. O\u010dek\u00e1v\u00e1n\u00ed pacient\u016f a jejich rodin je obrovsk\u00e9, jak\u00e9koliv zhor\u0161en\u00ed zdravotn\u00edho stavu nebo nedej bo\u017ee \u00famrt\u00ed v nemocnici se pova\u017euje p\u0159inejmen\u0161\u00edm za pochyben\u00ed zdravotn\u00edk\u016f nebo rovnou za krimin\u00e1ln\u00ed \u010din. My l\u00e9ka\u0159i p\u0159em\u00fd\u0161l\u00edme, jakou dal\u0161\u00ed l\u00e9\u010dbu nasadit, jakou dal\u0161\u00ed chorobu l\u00e9\u010dit, jakou citliv\u011bj\u0161\u00ed diagnostickou metodu pou\u017e\u00edt. St\u00edr\u00e1 se hranice mezi zdrav\u00edm a nemoc\u00ed. Ob\u010das d\u011bl\u00e1me ze zdrav\u00fdch nemocn\u00e9,\u201c <\/em>dod\u00e1v\u00e1 MUDr. Raku\u0161an. <\/p>\n\n\n\n

P\u0159i l\u00e9\u010db\u011b je dle n\u011bj t\u0159eba zohlednit i osobnost konkr\u00e9tn\u00edho pacienta. \u201ePro v\u00e1\u017en\u011b nemocn\u00e9 je nap\u0159\u00edklad nejcenn\u011bj\u0161\u00ed komoditou \u010das a ten p\u0159i nadbyte\u010dn\u00fdch cest\u00e1ch do nemocnice za vy\u0161et\u0159en\u00edmi ztr\u00e1c\u00ed,\u201c <\/em>dod\u00e1v\u00e1 l\u00e9ka\u0159 MUDr. Ji\u0159\u00ed Cyrany, Ph.D., z\u00a0kr\u00e1lov\u00e9hradeck\u00e9 fakultn\u00ed nemocnice.<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

\u010ce\u0161t\u00ed internist\u00e9 se sna\u017e\u00ed o zm\u011bnu \u2013 cht\u011bj\u00ed m\u00e9n\u011b zbyte\u010dn\u00fdch vy\u0161et\u0159en\u00ed \u010ce\u0161t\u00ed pacienti \u010dasto u\u017e\u00edvaj\u00ed zbyte\u010dn\u011b moc l\u00e9k\u016f, a ty jim pak mohou u\u0161kodit. Proch\u00e1zej\u00ed […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":19818,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-43398","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/43398","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=43398"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/43398\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/19818"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=43398"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=43398"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=43398"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}