School-based health centers met the criteria of a medical home for adolescents in a low-income urban population and often function as the primary source of care for students, according to a recent study.
The study surveyed students and parents of students who attended 1 of 10 middle and secondary schools in Denver with a school-based health center (SBHC), Dr. Sean O’Leary of the University of Colorado, Aurora, and his associates said. A total of 197 adolescents who had visited an SBHC during the 2011-2012 school year answered a survey, and 181 parents of different adolescents who also had visited an SBHC responded to a different, but related survey (Pediatrics 2014:134:5:1-8 [doi:10.1542/peds.2014-0296]).
Both surveys asked questions about how their experiences at SBHCs related to seven criteria of the medical home: accessibility, patient- and family-centeredness, continuity, comprehensiveness, coordination of care, compassion, and cultural effectiveness. At least two-thirds of both adolescents and parents responded favorably in all categories. Nearly 80% of adolescents and parents reported SBHCs were easily accessible, and more than 80% reported SBHCs were a kind and caring place to be seen for health care and were sensitive to cultural values. Nearly all students reported that they were very or somewhat satisfied with the services they had received. The top three services for which students sought care were illnesses, vaccines, and education about sexual health.
SBHCs were already functioning as the primary source of care for a third of students, Dr. O’Leary and his associates reported. Denver Health and Hospital Authority clinics were the second-most-common primary care source, with a reported rate of about 45% of students who did not use an SBHC as a primary care source, followed by private physicians’ offices, Kaiser Permanente clinics, other places, none, and emergency departments. Students who had no health insurance were more likely to use SBHCs as the primary source of care, and parents who valued access to mental health services also were more likely to report an SBHC was the primary source of care for their child.
While a majority of adolescents in the survey reported another source of primary care, more than half reported receiving a regular checkup at their SBHC, a service typically provided by the primary care provider, and two-thirds of those who identified another primary care source visited an SBHC at least three times. This raises “the possibility that the SBHC was functionally the primary source of care” for more students then those who reported it, Dr. O’Leary and his associates noted.
The authors had no relevant financial disclosures to report.