How one Nebraska addiction psychiatrist advocates for her patients


When Alëna Balasanova, MD, began the addiction psychiatry consultation-liaison service on the College of Nebraska Medical Heart with a colleague two years in the past, even she didn’t notice how a lot it could turn out to be a part of the tradition of her hospital.

From growing protocols and processes for sufferers with substance-use problems (SUDs) getting surgical procedure to routine consults together with her inside drugs and surgical colleagues, Dr. Balasanova says she’s most happy with the team-based tradition she’s been capable of assist create.

“With the previous 12 months and COVID, whereas hospital occupancy typically went down, our census on the habit seek the advice of service elevated exponentially,” mentioned Dr. Balasanova. “As alcohol and drug use have sharply risen, there’s been a good larger want to make sure evidence-based care throughout a number of settings.”

For medically and surgically hospitalized sufferers, there’s now a multidisciplinary workforce consisting of the school psychiatrist, interns and residents in psychiatry, social work, medical college students, well being professions college students, and habit drugs and ache drugs fellows.

“Now we have developed an in depth relationship with the infectious illnesses workforce to assist educate and assist OPAT [Outpatient Parenteral Antimicrobial Therapy] for sufferers who inject medicine [PWID],” mentioned Dr. Balasanova. “There has traditionally been hesitancy to discharge PWID with PICC traces for IV antibiotics. Now we have labored collectively to assist cut back threat and enhance SUD therapy referrals. It’s win-win.”

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Dr. Balasanova additionally sees the creation of protocols and order units within the system EMR  for hospitalized sufferers with SUDs as some of the promising and difficult efforts over the previous two years.

“We have been getting loads of calls about find out how to deal with pre-op sufferers on drugs for opioid-use dysfunction [MOUD],” she mentioned. “Working with our acute ache service, we have now established a protocol in order that sufferers aren’t pressured to cease taking buprenorphine preoperatively after which post-surgery, they’re rigorously monitored and continued on buprenorphine remedy to take care of therapy. It’s simply good medical care.”

Regardless of the appreciable effort already, Dr. Balasanova mentioned the work is simply starting.

“We’re going to quickly have training and coaching for each doctor, nurse, pharmacist and different well being care professionals within the hospital about administration of opioid withdrawal” she mentioned. “It’s been fantastic to have institutional management’s assist in addition to the assist of all my colleagues all through the hospital in enterprise this necessary undertaking.”

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Working with the Nebraska Medical Affiliation (NMA), Dr. Balasanova can also be spearheading legislative efforts to remove prior authorization for MOUD. Nebraska is one among roughly 25 states that also enable medical insurance firms to disclaim and delay MOUD regardless of its confirmed effectiveness to assist sufferers stay in therapy, assist preserve households and employment, and save lives.

“It’s a type of hurdles that medical insurance firms say is there to enhance affected person security, however you’ll by no means see ‘prior authorization protocol’ in any authoritative textbook, grand rounds presentation, or evidence-based analysis on bettering care,” mentioned Dr. Balasanova. “My sufferers need to get higher and lead secure lives, and each prior authorization places that in jeopardy.”

There’s a invoice within the Nebraska laws this 12 months, LB 413, that will put an finish to most prior authorizations for MOUD. Already, there was good progress to teach lawmakers and state officers about why it’s obligatory.

“Identical to Dr. Balasanova has labored onerous within the hospital to teach her colleagues, we do the identical factor on the state legislature,” mentioned Dexter Schrodt, NMA vice chairman for advocacy and regulation. “The prospects look good for LB 413, however we have now work to do—speaking about habit and prior authorization is sophisticated, however we’re dedicated to getting this invoice completed.”

The AMA believes that science, proof and compassion should proceed to information affected person care and coverage change because the nation is dealing with a extra harmful and complex illicit drug-overdose epidemic. Be taught extra on the AMA’s End the Epidemic website, the place this doctor profile was initially revealed.

The Finish the Epidemic web site was acknowledged by the Academy of Interactive and Visible Arts. As a part of that group’s twenty seventh Annual Communicator Awards, Finish the Epidemic was honored with an Award of Excellence within the Trigger & Consciousness web site class.


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