School-based health centers and adolescent use of primary care and hospital care
Open accessAbstract
PURPOSE: Little is known about the impact of school-based primary care on adolescents' use of hospital and emergency room care. METHODS: Students (grades 6-12) in nine Baltimore schools with school-based health centers and four schools without health centers were surveyed in May 1991 using an anonymous classroom questionnaire. Self-reported use of primary care services and emergency rooms and hospitalization were examined over the academic year. Logistic regression was used to assess factors influencing use of health care including the presence of a school health center. RESULTS: Students (n = 3,258) in health center schools and comparison schools reported similar rates of chronic health conditions. Students from schools with health centers were more likely to report seeing a social worker or counselor and more likely to report the use of certain health services in the past 4 years. Self-reported emergency room use (38%) and hospitalization (19%) were common. Students in schools with health centers were less likely to report hospitalization (OR = 0.80, 95% CI = 0.66-0.98). Emergency room use was also lower but only for students attending the school with a health center for more than 1 year (OR = 0.78, 95% CI = 0.62-0.99). Significant predictors of hospital care included reporting one or more chronic health condition, having health insurance, being of African-American race, or older age, and lower grade. CONCLUSIONS: Access to school-based, primary health care for adolescents was associated with increased use of primary care, reduced use of emergency rooms, and fewer hospitalizations. These findings have implications for both access to primary care and funding of school-based primary care.
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Previous reviews have found limited evidence of SBHC effectiveness in improving healthcare utilization and academic outcomes.
“Previous reviews have found limited evidence of SBHC effectiveness in improving healthcare utilization and academic outcomes.19,37–41”
From School-Based Health Centers to Advance Health Equity (2016) · cites this paper as [40]
The Discussion reports mixed utilization findings: the Baltimore study found increased use of some primary-care services and reduced hospital care, but also calls for further study of emergency-room use. It found no difference in school attendance because of illness. This paper is an original study, not a review, and it does not assess academic outcomes beyond attendance. (LLM, conf=0.84)
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- Authors
- Santelli, J., Kouzis, A., & Newcomer, S.
- Affiliations
- Johns Hopkins University (US)
- National Institutes of Health (US)
- Centers for Disease Control and Prevention (US)
- ORCID
- Santelli, John
- Venue
- Journal of Adolescent Health
- Publisher
- Elsevier BV
- Published
- 1996-10
- Volume
- 19
- Issue
- 4
- Pages
- 267-275
- ISSN
- 1054-139X (ISSN-L)
- OpenAlex
- W2040132122
- Cited by
- 73
- References
- 11
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2021: 1 · 2020: 1 · 2019: 1 · 2016: 5 · 2015: 4 · 2014: 1 · 2013: 1 · 2012: 6
- FWCI
- 11.75
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Adolescent Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Keywords
- school-based health centers, emergency department utilization, hospitalization, primary care utilization, health care access, chronic disease, health insurance, racial disparities in health care
- MeSH terms
- Adolescent, Emergency Service, Hospital, Female, Health Services Accessibility, Hospitalization, Humans, Male, Maryland, Primary Health Care, Surveys and Questionnaires, School Health Services, Logistic Models
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