School-based health centers and adolescent use of primary care and hospital care

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 roam 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, of 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.