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: Stu dents (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 exa mined over the academic year. Logistic regression was used to assess f actors influencing use of health care including the presence of a scho ol health center. Results: Students (n = 3,258) in health center schoo ls and comparison schools reported similar rates of chronic health con ditions. 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. Studen ts in schools with health centers were less likely to report hospitali zation (OR = 0.80, 95% CI = 0.66-0.98). Emergency roam use was also lo wer but only for students attending the school with a health center fo r more than 1 year (OR = 0.78, 95% CI = 0.62-0.99). Significant predic tors of hospital care included reporting one or more chronic health co ndition, having health insurance, being of African-American race, of o lder age, and lower grade. Conclusions: Access to school-based, primar y health care for adolescents was associated with increased use of pri mary 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.