Pediatric patients with chronic conditions frequently have unmet care needs, make extensive use of healthcare services, and often encounter fragmented, non-centered care. This study aimed to analyze the differences in the utilization of primary care (PC) and hospital care (HC) services by these patients according to sex, age, and complexity and to identify associated factors. A cross-sectional study was conducted in a basic health area of Madrid, including patients under 18 years. Among these patients, 15.7% had ≥1 chronic disease, 54.1% were male, the average age was 9.5 years, 3.5% had complexity, and 11.3% had multimorbidity. The mean number of contacts/year with the healthcare system was 9.1, including 8.3 contacts/year with PC (4.9 with pediatricians and 1.9 with nurses) and 0.8 contacts/year with HC (0.8 in external consultations and 0.01 hospitalizations). The factors associated with PC utilization were complexity; female sex; European origin; and diseases like asthma, epilepsy, stroke, recurrent urinary infection, attention deficit hyperactivity disorder, and anxiety, while older age was negatively associated. Thyroid disorders were significantly associated with HC utilization. These findings could help guide the design of optimized pediatric patient-centered care approaches to coordinate care across healthcare services and reduce high healthcare utilization, therefore improving the healthcare outcomes and quality of life for these patients.

Background: Many schools are committed to the “Five Steps to a Health Promoting School guide” created by the Schools for Health in Europe (SHE) network to avoid chronic disease and promote healthy environments. Objectives: The aim of this study was to evaluate schools’ health promotion policies and practices via the SHE rapid assessment tool. Methods: From February 2019 to June 2019, a cross-sectional survey based on this tool was conducted in nine international schools that are part of a private network operating in multiple countries. The entire school community was offered the opportunity to participate. The survey consisted of 37 questions aligned with the whole-school approach to health promotion and addressed orientation, healthy school policy, the physical and social environment, health skills, community links, and staff well-being using a three-point scale. A univariate analysis was subsequently performed. Results: A total of 929 people responded, 59.7% of whom were women, representing 74 different nationalities (82.5% Europeans). The average age was 25.9 years, ranging from 7 to 77 years. The participants included 57.2% students, 21.3% teachers, 15.3% families, 3.2% management teams, 1% counsellors/psychologists, 1% administrative/service staff, 0.5% catering staff, 0.3% nursing/medical staff, and 0.2% maintenance staff. The findings revealed that 80% of the respondents felt that most of these health promotion needs were being partially or fully addressed, predominantly with medium or high priority. However, 30% of the respondents indicated that the school had not yet assessed the students’ and employees’ health and well-being needs or fully promoted a healthy work-life. Conclusions: The SHE rapid assessment tool serves as an effective initial step in identifying key indicators within the school community, offering insights for future action towards becoming a health-promoting school. These results underscore the importance of addressing social and behavioural determinants of health within different international educational settings to promote positive sociorelational well-being and youth development. By fostering the well-being of children, adolescents, and the educational community, schools play a pivotal role in reducing the risk factors for chronic diseases and supporting psychosocial adaptation.