Physician Experiences of Substance Use Disorder Management in Pediatric Hospitals: A Qualitative Study of Key Informant Interviews.

purposeThe aim of this qualitative study was to describe the state of inpatient care of adolescent and young adults (AYAs) who are treated for substance use disorder (SUD)-related issues in a selection of pediatric hospitals.

methodsWe recruited physicians from nine institutions that receive funding through the Leadership Education in Adolescent Health grant. Semistructured, key-informant interviews (n = 12) were administered, transcribed, and coded for descriptive analysis. Themes and descriptive findings were then summarized.

resultsThe findings indicated similarities in the disciplines involved in inpatient care, and differences included medications offered, types of psychosocial support, and connection to other levels of care. The following eight themes emerged from qualitative analysis: (1) there is insufficient training and experience in addiction care and systems of SUD care in younger populations; (2) clinical pathways/algorithms standardize practice; (3) medical problems are prioritized over SUD care during admissions; (4) access to SUD care has many facilitators/barriers (e.g., insurance, geography, and legal concerns); (5) lack of data in children's hospitals is associated with lack of resource allocation; (6) attitudes toward addiction and AYAs can hinder or facilitate care; (7) SUD in AYAs has been under-recognized and the need for care is increasing; and (8) individuals and/or collaborative champions promote positive change. DISCUSSION: This is the first qualitative descriptive study to characterize the management of substance use-related issues in selected pediatric hospitals. By characterizing this care, we can target potential solutions and advocate for changes within hospitals, public policies, and training programs to address this unmet need.