Background:

Wellness Centers are full-scope school-based health centers in LAUSD serving students and community members in high-need neighborhoods. Surrounding Wellness Centers communities experience high levels of health disparities and poor access to healthcare, which were likely exacerbated by the COVID-19 Pandemic. School-based health centers are thought to decrease access barriers and reduce health disparities when schools are open. Studies suggest large declines in primary care and urgent care encounters in other clinical settings during the pandemic but it is unknown how the pandemic and related school closures affected school-based health center utilization.

Specific Aim:

Characterize the utilization of LAUSD WCs by students and community members before and during the COVID-19 pandemic.

Methods:

Secondary analysis of deidentified encounter data from 16 WCs from 7/1/15 to 3/31/2021. We defined the pandemic period as any encounter after 03/01/2020 to account for monthly billing schedules and align with COVID-19 school closures. Chi-Square Tests, using the svy suite of commands in STATA to account for clustering within clinics, were used to compare patient and encounter characteristics before and during the COVID-19 pandemic.

Results:

WCs maintained, on average, 75% of their pre-pandemic volume and served 1,575 students at over 11,000 encounters in 11 of the 15 Wellness Centers that remained open despite pandemic-related school closures. The proportion of student aged (ages 6-19) patients and encounters declined significantly during the pandemic from 23% of patients and 32% of encounters down to11% of patients and 16% of encounters.  However, there were no significant changes in utilization by gender or race. We also noted differences in the most common diagnoses for student encounters with obesity increasing in prevalence and STI testing and sports physical decreasing in prevalence during the pandemic.   

Conclusions:

WCs maintained a high level of clinical activity despite school closures but the proportion of adolescent patients accessing WCs declined during the pandemic. Fewer students accessing the WCs for sexual health services may indicate greater unmet health needs for high-risk students because it is generally understood student seek sexual health services at WCs.