health care utilization behaviors of school-based health center users and non-users gorette amaral,...
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Health care utilization behaviors of school-based health center users and non-users
Gorette Amaral, MHS; Sara P. Geierstanger, MPH; Samira Soleimanpour, MPH (Presenter); Claire Brindis, DrPH
Institute for Health Policy Studies, University of California San Francisco
American Public Health Association Annual Meeting ● November 8, 2004 ● Washington, DC
Learning Objectives Evaluate the extent to which school-based health
centers (SBHCs) act as a primary source of health care for adolescents and recognize other sources of care used by SBHC users and non-users
Describe the relationship between insurance status and the likelihood of an adolescent seeking SBHC services
Discuss the role SBHCs can play in increasing access to and utilization of preventive health services among users
Background and Methods
What are School-Based Health Centers (SBHCs)?
SBHCs provide an integrated health care approach with a focus on prevention and early intervention for adolescentsScreening, diagnosis, and treatment of
medical and mental health problemsReferrals and linkages to community
providers and resourcesHealth education (individual and school-wide)
Number of SBHCs, by State
1983 1990 1992 1994
1996 1998
101
440
00 0
0
2 33
1
20
26
1
3842
20
44159
31
32
17
15346
41
26
40
6
43
7 3
12
32
6
80
70
30116
102
7
11
3 3
56717
27592
2000
150
1,380
Source: The George Washington University, 2001.
Alameda County, California
Alameda County SBHC Coalition
Formed in 1996 with 3 SBHCs
Currently includes 1 middle and 10 high schools
Since 1997, UCSF has been outside evaluator Work with staff to design
and implement evaluation
Provide TA to sites to implement evaluation strategies
Assist with dissemination of evaluation findings
Fremont High School’s Tiger Health Clinic, Oakland, CA
Data Source and Analysis
California Healthy Kids Survey, 1999-2002 Cross-sectional, school-wide survey Administered to grades 9 and 11 at seven high
schools with SBHCs in Alameda County, CA N = 3,705, 39% response (Range: 21-52%)
Statistical analyses Chi squared tests of significance Multivariate logistic regression
Primary research questions
How do SBHC users and non-users differ on…? “Usual” source of health care Insurance status Receipt of specific health care services in the past
year
Findings
Sample Characteristics 28% of sample had
ever used their school’s SBHC (Range: 15-47%)
No significant gender difference between users and nonusers
Whites and African Americans significantly more likely to be users; Asians more likely to be nonusers (p<0.05)
28%
17%
28%
23%
8%5%
34%
12%13%11%
4%
8%
24% 25%
White African Amer. Asian Hispanic Pac. Islander Amer. Indian Other
Users (n=1,047) Nonusers (n=2,658)
10%
2%
3%
5%
5%
34%
41%
0%
8%
2%
2%
5%
5%
31%
40%
7%
Other
Emergency room
Family planning clinic
I have nowhere to go for care
Community clinic
Private doctor’s office
Kaiser hospital
SBHC **
SBHC users (n=1,047)
Non-users (n=2,658)
“Usual” source of health care
Of users, 7% reported SBHC as primary source No other significant differences between users
and non-users on “usual” source of care
** p<0.01
Health Care Payment Method
Private insurance,
52%Cash or no way to pay,
10%
Other, 2%
Not sure, 22%
Govt. Assistance,
14%
Over half (52%) of all students had private insurance
No significant differences in insurance status between SBHC users and non-users
Source: California Healthy Kids Survey, 1999-2001, N=3,705
Insurance & SBHC Use
Adjusted‡ Odds Ratios (95% CI)
Ever used SBHC,
any service
Ever used SBHC counseling services
Private insurance (reference) 1.00 1.00
Government assistance 1.10 (0.88, 1.39) 1.63 ** (1.24, 2.14)
No insurance 0.96 (0.74, 1.25) 1.64 ** (1.20, 2.23)
Not sure 0.84 (0.69, 1.02) 0.92 (0.70, 1.20)
‡ Adjusted for grade, gender, ethnicity, school attended, and self-reported health status.
* p<0.05, ** p<0.01
Insurance status was not a predictor of general SBHC use (“Have you ever used the SBHC for any service?”)
However, having public insurance or being uninsured significantly increased the odds of SBHC counseling service utilization
Receipt of specific services
8%
10%
2%
3%
16%
31%
8%
11%
7%
6%
22%
36%
Minor illness
Minor injury/accident
Birth control **
Counseling **
Sports physical **
Check-up **
SBHC users (n=1,047)
Non-users (n=2,658)
* p<0.05, ** p<0.01Respondents could mark more than one answer, so totals do not necessarily add up to 100%.
SBHC users and non-users had similar rates of seeking care for minor illness or injury in prior year
However, users were more likely than non-users to have received important preventive services
Limitations
Cross-sectional design Self-reported health behaviors and insurance
status Response rate varied from 21-52% across sites Possible non-representativeness of sample
Summary of Findings
Generally, users and non-users did not differ on “usual” source of care or insurance status
However, having public or no insurance increased the odds of seeking SBHC counseling services
Among SBHC users, 7% indicated the SBHC was their primary source of health care
SBHC users and non-users had similar rates of treatment for acute services in past year, but SBHC users were more likely than non-users to have received a number of important preventive services
Conclusions / Implications
Although few students named the SBHC as their primary source of health care, SBHCs are a significant source of secondary care.
In particular, SBHCs may increase access to and utilization of essential preventive services which adolescents need to remain healthy.
SBHCs are able to attract students regardless of insurance status, suggesting they possess characteristics that students may not find elsewhere (e.g., confidentiality, teen-friendly environment and staff, geographic accessibility).
For more information
Alameda County School-Based Health Center EvaluationInstitute for Health Policy Studies
University of California, San Francisco
Gorette Amaral, MHSResearch Analyst, gorette @ itsa.ucsf.edu
Sara Peterson Geierstanger, MPHProject Director, sara @ itsa.ucsf.edu
Samira Soleimanpour, MPHProject Coordinator, samira @ itsa.ucsf.edu
Claire Brindis, DrPHPrincipal Investigator, brindis @ itsa.ucsf.edu