School-Based Health Centers and the Utilization of Primary Care in Rural Communities.

Abstract

School-based health centers (SBHCs) in rural communities improve students' access to primary care, but evidence on service utilization patterns is limited. The 2011-2017 electronic health record data for students (aged 5-18 years) who used primary care were analyzed to compare utilization patterns (total number of office visits, well-child, immunization, chronic-condition visits) in a 4-county rural region of New York. Students were categorized into no-SBHC-access (living in school districts without SBHCs) and SBHC-access (living in districts with SBHCs). Students with SBHC-access were further categorized into SBHC-non-users (with SBHCs access but not using SBHCs), SBHC-only-users (only using SBHCs), and hybrid users (using SBHCs and other primary care providers). Treatment effects of SBHC-access and usage categories were estimated, adjusting for age, sex (defined in health record), year, community-level socioeconomic factors, and student/school district random effects. Hybrid-users' visits were stratified by site (SBHCs versus non-SBHCs clinic). Analyses were performed in 2025. Students with SBHC access included 24% SBHC-non-users, 52% SBHC-only-users , and 24% hybrid users. SBHC-access category was associated with greater primary care utilization than no-SBHC-access category. Results differed within SBHC-access: hybrid users had the highest utilization, whereas SBHC-non-users had the lowest. SBHC-only-users had more office visits and were more likely to have immunizations than students without SBHCs access. Hybrid users had more office visits and immunizations at SBHCs than at other primary care clinics. SBHCs increased overall office visits and immunizations among students using primary care in this rural region. Promoting SBHCs enrollment and use is important because effects were seen only among students who utilized the SBHCs.