The effects of regular source of care and health need on medical care use among rural adolescents

Objective: To examine those factors associated with the use of different ty pes of ambulatory health services in a rural adolescent population. Methods: The student bodies of 2 middle schools and 2 high schools in rural areas in a mid Atlantic state (N=1615) were surveyed using a self-administ ered health status and health services use instrument. Logistic regression was used to assess factors predicting receipt of (I) preventive services, ( 2) problem-focused services, and (3) emergency services. Results: One third of the rural youth reported having received preventive s ervices within the previous 3 months; 41% received problem-focused care, an d 18% received emergency services. Having the same provider for both preven tive and illness care tvas the most consistent and significant predictor of receipt for all types of ambulatory services. Of special note is the great er use of emergency services when subjects did not have a consistent provid er for both preventive and illness care. Health need variables, measured ac ross a wide range of domains, were additionally predictive, and their signi ficance varied according to the type of services received. Conclusions: This study provides compelling evidence that for rural adolesc ents, having a regular source of care and medical need are the most importa nt predictors of use across a variety of types of ambulatory care.