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Health care utilization behaviors of school-based health center users and non-users

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Administered to grades 9 and 11 at seven high schools with SBHCs in Alameda County, CA ... Alameda County School-Based Health Center Evaluation. Institute for ... – PowerPoint PPT presentation

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Title: Health care utilization behaviors of school-based health center users and non-users


1
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
2
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

3
Background and Methods
4
What are School-Based Health Centers (SBHCs)?
  • SBHCs provide an integrated health care approach
    with a focus on prevention and early intervention
    for adolescents
  • Screening, diagnosis, and treatment of medical
    and mental health problems
  • Referrals and linkages to community providers and
    resources
  • Health education (individual and school-wide)

5
Number of SBHCs, by State
1,380
10
17
1
0
3
44
3
20
0
0
38
44
159
0
42
31
7
17
26
0
1
56
20
43
32
27
2
33
34
102
15
59
1
6
6
2
41
12
116
7
30
6
26
3
32
7
40
70
1
1
80
150

1996
1998
2000
1994
1983
1990
1992
Source The George Washington University, 2001.
6
Alameda County, California
7
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 Schools Tiger Health Clinic,
Oakland, CA
8
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

9
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

10
Findings
11
Sample Characteristics
  • 28 of sample had ever used their schools 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 (plt0.05)

12
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

plt0.01
13
Health Care Payment Method
  • 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, N3,705
14
Insurance SBHC Use
  • 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

Adjusted Odds Ratios (95 CI) 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.
plt0.05, plt0.01
15
Receipt of specific services
  • 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

plt0.05, plt0.01 Respondents could mark more
than one answer, so totals do not necessarily add
up to 100.
16
Limitations
  • Cross-sectional design
  • Self-reported health behaviors and insurance
    status
  • Response rate varied from 21-52 across sites
  • Possible non-representativeness of sample

17
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

18
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).

19
For more information
  • Alameda County School-Based Health Center
    Evaluation
  • Institute for Health Policy Studies
  • University of California, San Francisco
  • Gorette Amaral, MHS
  • Research Analyst, gorette _at_ itsa.ucsf.edu
  • Sara Peterson Geierstanger, MPH
  • Project Director, sara _at_ itsa.ucsf.edu
  • Samira Soleimanpour, MPH
  • Project Coordinator, samira _at_ itsa.ucsf.edu
  • Claire Brindis, DrPH
  • Principal Investigator, brindis _at_ itsa.ucsf.edu
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