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Primary Submission Category: Health equity

School-based health centers and the utilization of primary care in rural communities

Authors:  Xue Zhang, Sharon Tennyson, Chris Kjolhede, Wendy Brunner,

Presenting Author: Xue Zhang*

School-based health centers (SBHCs) in rural communities have the potential to improve students’ access to primary care, but evidence on service utilization patterns is limited. 

2011-2017 medical encounter data were used to examine primary care utilization (number of office visits, well-child, immunization, chronic-condition visits) for students with/without SBHC access in a four-rural-county region of New York. Students with SBHC access were stratified into those relying solely on SBHCs (SBHC-only-users), those using SBHCs and other care (hybrid-users), and those not using SBHCs (SBHC-non-users). Marginal effects of SBHC access and use were estimated, adjusting for age, sex, year, community-level socioeconomic factors, and student/school district random effects. Models were stratified by age groups (5-10, 11-18). Analysis was performed in 2025.

The comparison group was students without SBHC access. SBHC access was associated with greater use of primary care services. Hybrid-users and older students (ages 11-18) had the highest utilization, while SBHC-non-users had the lowest. 52% of SBHC users were SBHC-only-users. Those students had 0.61 more visits (95%CI: 0.54, 0.67) and were 14% more likely to have immunization visits (95%CI: 0.13, 0.15). Older SBHC-only-users were 9% more likely to have well-child visits (95%CI: 0.08, 0.11). Hybrid-users had more SBHC visits (0.97, 95%CI: 0.90, 1.04) and were more likely to use SBHCs for immunization visits (0.29, 95%CI: 0.28, 0.31).

Access to SBHCs increases primary care utilization in this rural region, especially for office visits and immunization visits among SBHC users and older students. Promoting students’ use of SBHCs is important.