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A Comparison Study of an Elementary School–Based Health Center
Effects on Health Care Access and Use
David W. Kaplan, MD, MPH;
Claire D. Brindis, DrPH;
Stephanie L. Phibbs, MPH;
Paul Melinkovich, MD;
Kelly Naylor, PhD;
Karin Ahlstrand, MA
Arch Pediatr Adolesc Med. 1999;153:235-243.
Objective To assess the effects of an elementary school–based health center (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 comparable intervention (SBHC) and a comparison of urban elementary schools.
Intervention Elementary SBHC services, including preventive physical health care; the care of minor short-term illnesses, injuries, and stable ongoing medical conditions; dental screenings; and mental health counseling.
Participants All parents of students at both schools were asked to complete 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 services, 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 physical health care for their children, ie, treatment of illnesses and injuries, immunizations, and physical examinations (odds ratio, 0.66; 95% confidence interval, 0.48-0.91). Access to an SBHC was independently and significantly related to less emergency department use (odds ratio, 0.63; 95% confidence interval, 0.40-0.99; P<.05), a greater likelihood of having had a physician'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 annual 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 their 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 variables, underserved minority children with SBHC access have better health care access and use than children without SBHC access, signifying that SBHCs can be an effective component of health delivery systems for these children.
From the Department of Pediatrics, University of Colorado School of Medicine, and Children's Hospital, Denver (Drs Kaplan and Naylor and Mss Phibbs and Ahlstrand); the Division of Adolescent Medicine, Department of Pediatrics, Institute for Health Policy Studies, University of California–San Francisco (Dr Brindis); and the Denver Health and Hospital Authority (Dr Melinkovich).
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