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COVER STORY
The goal is not to relieve all of a patient’s pain, but to achieve a tolerable level of pain that allows patients to reach their goals.
“We’re turning our focus to preserving function, including in the hospital,” she said. For hospital patients, that could mean attending physical therapy or walking to the bathroom independently.
Achieving that function requires a personalized approach, including the patient’s substance-use history, toleration of medication and goals.
ADVOCATING FOR ACCESS
The expansion of Medicaid in 31 states in 2014 as part of the Patient Protection and Affordable Care Act helped Delaware’s community providers expand access to substance-use care. This coverage is especially important in treating addiction, because the disease’s progression often inhibits the victim’s ability to work and receive employer-sponsored coverage.
“If you repeal and replace the Affordable Care Act in a way that impacts Medicaid in our state, including the potential for 40,000 or 50,000 people to come off Medicaid rolls, you will remove the access to what is effectively life-saving treatment,” said Bettina Tweardy Riveros, Esq., Christiana Care’s chief health equity officer and senior vice president, government affairs and community engagement.
Throughout the past year, Christiana Care has been engaged with community leaders and government officials to help preserve access to care for people struggling with addiction. These efforts included successful state legislation that requires insurance companies and Medicaid plan participants to cover treatment for substance-use disorder.
INFANT VICTIMS OF ADDICTION
As Delaware’s leading maternity hospital, delivering more than 6,000 babies every year, Christiana Care is at the forefront in caring for infants who are exposed to drugs in the womb — and their families.
Infants who experience withdrawal after birth need their mothers more than anything else. Time spent together cements a bond and calms the infant, dampening the effects
of withdrawal. Their mothers need something else altogether: acceptance. Already stigmatized for their addiction, they are quick to sense the judgment, overt or subtle, of their health care providers.
Though doctors teach that addiction is a chronic disease and not a choice, the public is often inclined to demonize parents who struggle with addiction. This attitude is hurtful to parents but ultimately does the most damage to the infants, said David A.
Paul, M.D., chair of the Department of Pediatrics and clinical leader of the Women and Children’s Service Line.
“In order to solve this problem and care for infants, we have to care for the families,” Dr. Paul said. “If you blame the mother for causing the baby’s illness, then the parents pick up on that. If parents don’t feel welcome, they’re not going to be there as often. We need to have the parents engaged, and we need the moms breastfeeding and learning to take care of their infants.”
Christiana Care cares for about 200 infants a year who are exposed to opioids before birth. These infants develop neonatal abstinence syndrome, or NAS, which is essentially a set of short-term withdrawal symptoms with unclear long-term consequences.
Christiana Care has created a medical regimen that weans infants off opioids in the hospital and helps parents adjust to their new responsibilities. Christiana Care also has consolidated comprehensive services — including addiction psychology, midwifery and social services — into a pregnancy support center in Wilmington Hospital that opened in September.
Christiana Care cares for about 200 infants a year
who are exposed to opioids before birth.
These infants develop neonatal abstinence syndrome,
or NAS, which is essentially
a set of short-term withdrawal symptoms with unclear long-term consequences.
“We want to be able to give our patients the ability to have on- site, wraparound services,” said Elizabeth M. Zadzielski, M.D., MBA, FACOG, associate physician leader of the Women and Children’s Service Line.
Some infants undergoing withdrawal face complex medical needs that require care in Christiana Hospital’s Level III neonatal intensive care unit (NICU). For babies who | CONTINUED
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