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

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
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
Background and
Methods
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)
Number of SBHCs, by State
1,380
10
1
44
17
0
0
20
0
3 3
38
159
0
0
1
2
102
116
33
42
26
43
1
70
1
41
26
12
32
40
34 15
6
6
7
17
20
32
6
7
30
31
44
7
56
27
59
2
3
1
80
150
1983
1990
1992
Source: The George Washington University, 2001.
199
4
1996
1998
2000
Alameda County, California
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 School’s Tiger Health Clinic, Oakland, CA
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
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
Findings
Sample Characteristics



28% of sample had
ever used their
school’s 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
(p<0.05)
Users (n=1,047) Nonusers (n=2,658)
34%
28%
28%
24%
23%
25%
17%
13%
12%
11%
8% 8%
5%
White
African Amer.
Asian
Hispanic
4%
Pac. Islander Amer. Indian
Other
“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
7%
SBHC ** 0%
40%
41%
Kaiser hospital
31%
34%
Private doctor’s office
Community clinic
I have nowhere to go for care
Family planning clinic
Emergency room
Other
5%
5%
5%
5%
SBHC users (n=1,047)
Non-users (n=2,658)
2%
3%
2%
2%
** p<0.01
8%
10%
Health Care Payment Method

Over half (52%) of
all students had
private insurance

No significant
Other, 2%
differences in
Cash or no
insurance status
way to pay,
between SBHC
10%
users and non-users
Not sure,
22%
Govt.
Assistance,
14%
Source: California Healthy Kids Survey, 1999-2001, N=3,705
Private
insurance,
52%
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)
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
‡
Adjusted for grade, gender, ethnicity, school attended, and self-reported health status.
* p<0.05, ** p<0.01
(0.70, 1.20)
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
36%
Check-up **
31%
22%
Sports physical **
Counseling **
Birth control **
16%
6%
3%
7%
2%
11%
10%
Minor injury/accident
Minor illness
SBHC users (n=1,047)
Non-users (n=2,658)
8%
8%
* p<0.05, ** p<0.01
Respondents could mark more than one answer, so totals do not necessarily add up to 100%.
Limitations


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Cross-sectional design
Self-reported health behaviors and insurance
status
Response rate varied from 21-52% across sites
Possible non-representativeness of sample
Summary of Findings


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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
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).
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 @ itsa.ucsf.edu
Sara Peterson Geierstanger, MPH
Project Director, sara @ itsa.ucsf.edu
Samira Soleimanpour, MPH
Project Coordinator, samira @ itsa.ucsf.edu
Claire Brindis, DrPH
Principal Investigator, brindis @ itsa.ucsf.edu