title: Comparing frequent and average users of elementary school-based health centers in the Bronx, New York City.
abstract: This study analyzed health care utilization at three school-based health centers (SBHCs) in the Bronx, New York City, and compared characteristics of "frequent" and "average" service users. Encounter form data for visits by 2,795 students who received services at least once between September 7, 1998, and June 30, 1999, were reviewed. Demographic comparisons between clinic users and the total school population, and between "frequent" (five or more visits/year) and "average" (one to four visits/year) users were made. The two groups also were compared after primary diagnoses were classified into five general categories. Some 96% (3,469/3,614) of students were registered in the SBHCs, of whom 81% (2,795/3,469) used clinic services at least once during the school year. Clinic users did not differ from the general school population by gender, but were younger (p < 0.01). "Frequent" users were more likely than "average" users to be older (p < 0.01), but they did not differ by gender, race/ethnicity, or insurance status. "Frequent" users comprised 28% of the clinic-using population, but accounted for 72.5% of all visits. Similarly, "average" users comprised 72.4% of the clinic-using population, but accounted for 27.5% of all visits. "Frequent" users generated most visits for mental health and chronic medical conditions, while "average" users generated most visits for preventive care, acute medical care, and injuries/emergencies (p < 0.01 for all). Important challenges for elementary SBHCs include developing new approaches that meet children's needs while protecting clinic resources, like scheduling group interventions for those with on-going health care needs who require frequent use of school health services.
authors.affiliation: Montefiore School Health Program, Montefiore Medical Center, Albert Einstein College of Medicine, 3544 Jerome Ave., Bronx, NY 10467, USA. rbaquira@montefiore.org
authors.forename: Raymundo S
authors.initials: RS
authors.lastname: Baquiran
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: David K
authors.initials: DK
authors.lastname: Appel
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008507:Medically Underserved Area; D020380:Needs Assessment / Q000458:organization & administration; D009519:New York City; D012042:Registries; D012189:Retrospective Studies; D012572:School Health Services / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014600:Utilization Review