Access to Health Care

Adolescents Do Not Use the Health Care System Enough

Exam roomAdolescents have one of the lowest rates of primary care use of any age group in the United States.1 and adolescents from disadvantaged backgrounds are at the highest risk of not having regular health maintenance visits.2, 3

Children from low-income families experience disparities in health, which are due in part to barriers in access and utilization of health care. Poor health care access and utilization is influenced by factors including lack of health care providers, the intricacies of navigating a complex health care system, language barriers, and transportation.4

Being part of a racial or ethnic minority group, being poor, or being in a family that has recently immigrated to the United States may also contribute to decreased access to quality and appropriate health services.5

The highest standard of adolescent care, according to the American Academy of Pediatrics’ Committee on Adolescence, includes anticipatory guidance, screening, and counseling to reduce risks and increase health promoting behaviors. But such a standard is rarely achieved today; far too many adolescents, in fact, rely on our most costly delivery settings: emergency departments.6, 7

SBHCs Increase Access to Health Care

School-based health centers (SBHCs) are considered one of the most effective strategies for delivering preventive care, including reproductive and mental health care services, to adolescents—a population long considered difficult to reach. Numerous evaluations have shown that SBHCs achieve marked improvements in adolescent health care access when compared with adolescent utilization in other settings. This is especially true for important services delivered on-site, such as family planning, screening and counseling for sexually transmitted diseases, mental health, and substance abuse services.8, 9, 10, 11, 12, 13

A national multi-site study of school-based health centers conducted by Mathmatica Policy Research found a significant increase in health care access by students who used school-based health centers: 71 percent of students reported having a health care visit in past year compared to 59 percent of students who did not have access to an SBHC.14 Periodic surveys of SBHCs show that adolescents seen in SBHCs are likely to receive recommended services such as abstinence counseling (76 percent), pregnancy testing (78 percent), crisis intervention (91 percent), STD testing and treatment (62 percent), mental health assessment and diagnosis (91percent), and substance abuse counseling (77 percent). In contrast, state and local policies limit recommended adolescent services: oral contraceptives are available in 30 percent of SBHCs, pap smears in 42 percent, and HIV testing in 44 percent.15

References

(1)   Hing E, Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2004 summary. Advances in Data Analysis and Classification. Jun 23 2006(374):1-33.
(2)   Nordin JD, Solberg LI, Parker ED. Adolescent primary care visit patterns. Annals of Family Medicine. Nov-Dec 2010;8(6):511-516.
(3)   Irwin CE, Jr., Adams SH, Park MJ, Newacheck PW. Preventive care for adolescents: few get visits and fewer get services. Pediatrics. Apr 2009;123(4):e565-572.
(4)   Redmond P, Needleman C. Reducing Barriers to Health Care: Practical Strategies for Local Organizations – Covering Kids & Families Access Initiative Toolkit. Hamilton, NJ: Center for Health Care Strategies, Inc.;2007.
(5)   Wise PH. The transformation of child health in the United States. Health Affairs (Millwood). Sep-Oct 2004;23(5):9-25.
(6)   Partridge L, Szlyk C. National Medicaid HEDIS Database/Benchmark Project. Washington DC: American Public Human Services Association;2000.
(7)   {National Committee for Quality Assurance, 2010 #3957}
(8)   Allison MA, Crane LA, Beaty BL, Davidson AJ, Melinkovich P, Kempe A. School-based health centers: improving access and quality of care for low-income adolescents. Pediatrics. Oct 2007;120(4):e887-894.
(9)   Anglin TM, Naylor KE, Kaplan DW. Comprehensive school-based health care: high school students’ use of medical, mental health, and substance abuse services. Pediatrics. Mar 1996;97(3):318-330.
(10) Juszczak L, Melinkovich P, Kaplan D. Use of health and mental health services by adolescents across multiple delivery sites. The Journal of Adolescent Health. Jun 2003;32(6 Suppl):108-118.
(11) Kaplan D, Calonge B, Guernsey B, Hanrahan M. Managed Care and School-based Health Centers: Use of Health Services. Archives of Pediatric and Adolescent Medicine. 1998;152:25-33.
(12) Klein JD, Handwerker L, Sesselberg TS, Sutter E, Flanagan E, Gawronski B. Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users. The Journal of Adolescent Health. Aug 2007;41(2):153-160.
(13) Lancman H, Pastore DR, Steed N, Maresca A. Adolescent Hepatitis B Vaccination: Comparison among 2 High School-Based Health Centers and an Adolescent Clinic. Archives of Pediatric and Adolescent Medicine. Nov 2000;154(11):1085-1088.
(14) Kisker EE, Brown RS. Do school-based health centers improve adolescents’ access to health care, health status, and risk-taking behavior? The Journal of Adolescent Health. May 1996;18(5):335-343.
(15) Lofink H, Kuebler J, Juszczak L, et al. 2010-2011 School-Based Health Alliance Census Report. Washington, DC: School-Based Health Alliance;2013.

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