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BODKA ZA DISKUSIOU UNIVERSITATIS DISPUTATIONES 2014: Ktorý liek je pre mňa najlepší?


 | 18.11.2014 | komentárov: 304

Na Právnickej fakulte UPJŠ v Košiciach sa 12. novembra 2014 uskutočnila druhá diskusia v rámci projektu UNIVERSITATIS DISPUTATIONES 2014 realizovaného v Košiciach. Pozvaní hostia diskutovali na tému Ktorý liek je pre mňa najlepší? Kvalitná zdravotná starostlivosť vs. obmedzenosť zdrojov. UD 2014 je projekt univerzitných dišpút, ktorú už tretí rok organizuje Komora pre medicínske právo – MEDIUS. Tento ročník sme opäť zrealizovali v spolupráci s odbornými partnermi, ktorými sú Právnická fakulta UPJŠ a Lekárska fakulta UPJŠ. Nad projektom už tretí rok prevzal záštitu primátor mesta Košice – MUDr. Richard Raši, PhD., MPH. Projekt sa podarilo zorganizovať aj vďaka finančnej podpore GlaxoSmithKline (GSK) a spoločnosti Medtronic.

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Celá diskusia bola venovaná problematike vzťahu medzi poskytovateľom (lekárom) – zdravotnou poisťovňou a pacientom a dôležitosti komunikácie medzi týmito subjektmi, a teda mikroúrovni okruhu otázok, o ktorých sa debatovalo na bratislavských dišputách.   K predmetu diskusie sa vyjadrili PhDr. Mária Humeníková, MUDr. Iveta Rjašková – detská psychiatrička a JUDr. MUDr. Ján Uhrín – klinický psychiater. 

Druhú dišputu otvorila svojím príspevkom PhDr. Mária Humeníková.  Vo svojom vystúpení poukázala na špecifiká zdravotníckeho povolania. Medzi tieto patrí skutočnosť, že ide  o pomáhajúcu profesiu, v ktorej sú osoby náchylnejšie k vyhoreniu,  pričom zdravotník pristupuje k pacientovi v pozícii odborníka oblečeného v uniforme vyjadrujúcej jeho odlišný status. Zdravotník komunikuje v práci s pacientom, ktorému musí odborné znalosti „prekladať“ do zrozumiteľného jazyka, ďalej ale aj so zdravotnou poisťovňou (ak ide o poskytovateľa) alebo vedúcim pracovníkom. V komunikácii s pacientom sa môže stretávať aj s ďalšími problémami – pacient poskytuje nepresné informácie, nedodržiava pokyny lekára prípadne má pasívny prístup k liečbe. 

Ako druhá vystúpila MUDr. Iveta Rjašková, ktorá upozornila na dve úskalia svojej špecializácie– komunikácia s rodičom a systém vzťahov a podmienky, ako ich nastavuje legislatíva, v ktorých má poskytovateľ – lekár zdravotnú starostlivosť poskytovať.  Špecificky v starostlivosti o detského psychiatrického pacienta vidí ako problematický malú možnosť výberu z liekov, ktoré môže psychiater detskému pacientovi predpísať a sú hradené z verejného zdravotného poistenia. Inak, pokiaľ chce zvoliť účinnejšiu liečbu s rovnakými NU, musí PZP žiadať o schválenie neregistrovaného lieku MZ SR a  ZP o výnimku. Avšak je tu riziko, že po schválení a nasadení lieku táto liečba nebude účinná a celý proces o schválenie musí absolvovať znova...

Tretím rečníkom bol JUDr. MUDr. Ján Uhrin – psychiater. Vo svojom príspevku upozornil tiež na osobitné problémy vo vzťahu poskytovateľ – pacient – poisťovňa pri liečbe pacientov trpiacich psychickými ťažkoťami. Najprv, pre lepšie priblíženie problematiky nezdravotníckemu publiku,  rozlíšil pacientov, na tých ktorí trpia tými najzávažnejšími duševnými poruchami ako je napr.  schizofrénia alebo bipolárna afektívna porucha, pri liečbe ktorých je vždy potrebné nasadiť psychofarmaká. U druhej skupiny pacientov, ktorí prechádzajú náročnými životnými situáciami, reaktívnymi stavmi na stratu blízkeho, partnera, dieťaťa či zamestnania, ktorí prežívajú úzkosť, trpieť nespavosťou, depresívnymi stavmi. Pri liečbe týchto pacientov sa ponúkajú dve eventuality: nasadiť psychofarmaká alebo odporučiť psychoterapiu. Za ideálnu formu liečby prednášajúci označil  kombináciu oboch týchto prístupov. Vzápätí sa spýtal publika, čo si myslí, ktorá z možností je lacnejšia? Psychoterapia alebo liečba medikamentmi? Publikum stavilo na psychoterapiu, opak je ale pravdou, liečba medikamentmi je niekoľkokrát lacnejšia ako intenzívna psychoterapia.

Ďalej MUDr. Uhrin reagoval na otázku, či zainteresovať pacienta do rozhodovania o výbere lieku. Na základe skúseností zo svojej praxe konštatoval, že pacienti si vyhľadávajú informácie o liekoch na internete, rovnako získavajú informácie od iných pacientov. Pri liečbe psychofarmami  sa tiež vyskytujú nežiaduce vedľajšie účinky - napríklad priberanie na hmotnosti alebo sexuálne nežiaduce účinky. O sexuálnych nežiaducich účinkoch býva pre pacientov nepríjemné spontánne rozprávať, a veľakrát tieto lieky radšej sami vysadia bez konzultácie s lekárom. Preto by podľa názoru Dr. Uhrina mali byť brané do úvahy preferencie pacienta a považuje za vhodné, aby sa  ošetrujúci lekár spontánne pýtal na ťažkosti spojené s užívaním konkrétneho lieku. Vyjadril sa aj k otázkam vzťahu lekára a pacienta, poskytovateľa a zdravotnej poisťovne či lekára a lekárnika. Vyzdvihol dôležitosť komunikácie medzi lekárom a pacientom, ale pripomenul aj problém nedisciplinovanosti nemalej skupiny pacientov.

Po otvorení diskusie sa riešili otázky rozdielu medzi indikovaným liekom a registrovaným liekom, pretrvávajúceho stigmatizovania psychických porúch a chorôb, dôležitosti komunikácie, zvýšeného počtu detí s diagnózou ADHD, efektívnosti liečby, vhodnosti medikamentóznej liečby...

Diskusia bola odborná, zároveň vzala ponúkanú tému zo špecifického a veľmi zaujímavého uhla starostlivosti o psychiatrických pacientov.  Záznam a fotografie z diskusie sú dostupné TU.




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