School-based health centers may serve as patient-centered medical homes

1. School-based health centers (SBHCs) were shown to meet American Academy of Pediatrics (AAP) criteria for patient-centered medical homes (PCMHs) from parent and adolescent perspectives.

2. One third of parents and adolescents reported that SBHCs were their primary source of healthcare.

Evidence Rating Level: 3 (Average)   

Study Rundown: SBHCs show potential to increase access to care, however, there is concern among pediatricians that SBHCs may not meet the goals of the medical home model. The AAP defines PCMHs as “accessible, continuous, comprehensive, family-centered, coordinated, and compassionate”. This study surveyed adolescents and parents of adolescents who attended a middle or high school and used an SBHC. Overall, the survey responses indicated that SBHCs met the AAP criteria for PCMHs from a parent and patient perspective. Of note, a majority of both parents and students were generally satisfied with the care received. In addition, one third of parents and adolescents considered an SBHC to be their or their child’s source of primary care. The study is limited by the survey of a single population in a small, urban geographical area. Also, the SBHCs studied were integrated into a much larger health system, which may help mitigate a sense of fractured care. However, for the typically difficult-to-reach population of underinsured adolescents, SBHCs may offer an opportunity to increase access to care.

Click to read the study, published today in Pediatrics

Relevant Reading: School-based health centers: improving access and quality of care for low-income adolescents

Study Author, Dr. Sean O’Leary, MD, MPH, talks to 2 Minute Medicine: Children’s Hospital Colorado, Children’s Outcome Research, Assistant Professor of Pediatrics.

“School-based health centers are an important source of care for underserved youth. Trainees need to be aware of this ‘hidden health care system’ in the US, because for many adolescents, the school based health center is their only source of care.”

In-Depth [survey]: A survey was sent to a random sample of 500 students who attended an SBHC in the Denver area in 2011 to 2012 and a different sample of 500 parents. The response rate was 40% (197) for adolescents and 36% (181) for parents. The SBHCs examined were staffed by a nurse practitioner or physician assistant, offered usual vaccinations, and were part of the larger Denver Health system. Results indicated that parents and adolescents thought SBHCs did a good or excellent job of “being available when I/my child need(s) to be seen” (i.e. accessibility, 79% and 77%, respectively), had “medical providers that know me/my child” (i.e. continuity, 69% and 67%) and offered “lots of different services for my child’s needs” (i.e. comprehensiveness, 77% and 73%). Most parents and adolescents also felt SBHCs did a good or excellent job of making “sure that I/my child am/is able to see other medical providers if needed” (i.e. coordinated care, 74% and 73%) and provided “a kind, caring place for me/my child to be seen for health care” (i.e. compassionate care, 88% and 86%).Thirty three percent of adolescents and 34% of parents reported using an SBHC as their primary care provider.

More from this author: Childhood ADHD, stimulant treatment not linked with height, Healthcare-associated infections falling among critically ill children 

Image: PD

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