A comparison study of an elementary school-based health center - Effects on health care access and use

Objective: To assess the effects of an elementary school-based health cente r (SBHC) on access to and the use of physical and mental health services by children aged 4 to 13 years. Study Design: A retrospective cohort analysis of parent surveys from a comp arable intervention (SBHC) and a comparison of urban elementary schools. Intervention: Elementary SBHC services, including preventive physical healt h care; the care of minor short-term illnesses, injuries, and stable ongoin g medical conditions; dental screenings; and mental health counseling. Participants: All parents of students at both schools were asked to complet e a survey. Return rates on the survey were 78.3% (570/728) and 77.0% (440/ 571) at the intervention and comparison schools, respectively. Main Outcome Measures: The use of health services, access to health service s, and health service satisfaction. Results: Compared with respondents at comparison schools, respondents whose children had access to an SBHC had less difficulty (P =.01) receiving phys ical health care for their children, ie, treatment of illnesses and injurie s, immunizations, and physical examinations (odds ratio, 0.66; 95% confiden ce interval, 0.48-0.91). Access to an SBHC was independently and significan tly related to less emergency department use (odds ratio, 0.63; 95% confide nce interval, 0.40-0.99; P<.05), a greater likelihood of having had a physi cian's visit since the school year began (odds ratio, 1.92; 95% confidence interval, 1.39-2.65; P<.01), and a greater likelihood of having had an annu al dental examination (odds ratio, 1.36; 95% confidence interval, 1.01-1.83 ; P<.05). Measured by a 12-item scale, respondents who reported the SBHC as their most-used health service were significantly more satisfied with thei r service than respondents who mostly used community clinics (z = -5.21; P< .01) or hospital clinics (z = -4.03; P<.01). Conclusions: Independent of insurance status and other confounding variable s, underserved minority children with SBHC access have better health care a ccess and use than children without SBHC access, signifying that SBHCs can be an effective component of health delivery systems for these children.