Kaplan D W, Calonge B N, Guernsey B P, Hanrahan M B
University of Colorado School of Medicine, Denver, USA.
Arch Pediatr Adolesc Med. 1998 Jan;152(1):25-33. doi: 10.1001/archpedi.152.1.25.
To explore the use of physical and mental health services for adolescents who are enrolled in managed care and have access to a school-based health center (SBHC), compared with adolescents enrolled in managed care without access to an SBHC.
Retrospective cohort designed with age, sex, and socioeconomic status matching to compare the use of health services for adolescent members of Kaiser Permanente of Colorado (who had access to SBHCs) with those with no access.
The study included 342 adolescents, resulting in 3394 visits that occurred during 3 academic years. During the study, 240 adolescents with access to an SBHC were compared with 116 adolescents without access to an SBHC.
The use of primary and subspecialty medical, mental health, and substance abuse treatment services; the use of after-hours (emergent or urgent) care; and comprehensive preventive health supervision visits and documentation of screening for high-risk health behaviors.
Adolescents with access to SBHCs were more than 10 times more likely to make a mental health or substance abuse visit (98% of these visits were made at the SBHC) (P < .001). Adolescents with SBHC access had an after-hours (emergent or urgent) care visit rate of 0.33 to 0.52 visits per year less (38%-55% fewer visits) than adolescents without SBHC access, and, overall, made almost 1 additional medical visit per year. A greater percentage, 80.2%, of adolescents with access to SBHCs had at least 1 comprehensive health supervision visit compared with 68.8% of adolescents without access (P = .04). In addition, the adolescents with access were screened for high-risk behaviors at a higher rate.
School-based health centers seem to have a synergistic effect for adolescents enrolled in managed care in providing comprehensive health supervision and primary health and mental health care and in reducing after-hours (emergent or urgent) visits. School-based health centers are particularly successful in improving access to and treatment for mental health problems and substance abuse.
探讨参加管理式医疗且可使用校内健康中心（SBHC）的青少年与参加管理式医疗但无法使用SBHC的青少年相比，在身心健康服务使用方面的情况。
进行回顾性队列研究，按年龄、性别和社会经济地位匹配，比较科罗拉多州凯撒医疗机构（可使用SBHC）的青少年成员与无法使用SBHC的青少年成员的健康服务使用情况。
该研究纳入了342名青少年，在3个学年期间共产生3394次就诊。研究期间，将240名可使用SBHC的青少年与116名无法使用SBHC的青少年进行比较。
初级和专科医疗、心理健康及药物滥用治疗服务的使用情况；非工作时间（紧急或加急）护理的使用情况；全面预防性健康监督就诊以及高风险健康行为筛查的记录情况。
可使用SBHC的青少年进行心理健康或药物滥用就诊的可能性高出10倍以上（其中98%的此类就诊在SBHC进行）（P < 0.001）。与无法使用SBHC的青少年相比，可使用SBHC的青少年每年的非工作时间（紧急或加急）护理就诊率低0.33至0.52次（就诊次数少38% - 55%），总体而言，每年多进行近1次医疗就诊。可使用SBHC的青少年中有80.2%至少进行过1次全面健康监督就诊，而无法使用SBHC的青少年这一比例为68.8%（P = 0.04）。此外，可使用SBHC的青少年进行高风险行为筛查的比例更高。
校内健康中心似乎对参加管理式医疗的青少年具有协同效应，可提供全面健康监督以及初级健康和心理健康护理，并减少非工作时间（紧急或加急）就诊。校内健康中心在改善心理健康问题和药物滥用的就医机会及治疗方面尤其成功。
