Associating school doctor interventions with the benefit of the health check: an observational study

Abstract

BackgroundThe benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks.MethodsBetween August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression.ResultsDoctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91–17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit.ConclusionsDoctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor.Trial registration numberNCT03178331.

Growing up unequal? Socioeconomic disparities in mental disorders throughout childhood in Finland

“…In addition, the services are mostly free for children under 18 years. Furthermore, comprehensive child health clinics and school health care system with regular health checks for all children ensure that identifying mental health disorders is not based only on parents' own activity and knowledge (see Nikander, Kosola, Vahlberg, Kaila, & Hermanson, 2022 ; Poutiainen, Hakulinen, Mäki, & Laatikainen, 2016 ).…”

Parent, teacher, and nurse concerns and school doctor actions: an observational study of general health checks

“… 12 Parents value immediate help from the school doctor compared with referrals to other professionals. 14 Unnecessary steps before providing treatment for concerns (failure demand) should be avoided and flexibility of appointment times ensured when developing the roles, training, and multiprofessional collaboration of nurses and doctors in school health care. 33 34 The future visions of mental health services in the school environment include a multiprofessional team providing help on physical and psychosocial health questions.…”

“…The doctors conducted actions in 78% of the 1013 health checks. 14 The actions included instructions and/or significant discussions (60%), follow-up appointments (17%), referrals to other professionals within schools or community services (13%), prescriptions (10%), laboratory tests and/or medical imaging (9%), and referrals to specialised care (5%).…”

“…13 In our previous study, however, Finnish school doctors undertook actions in four-fifths of the health checks. 14 In Finland, the preventive health care system is extensive, free of charge, and legally regulated starting from pregnancy throughout school age. 15 16 School health services are mandated to offer routine health checks by school nurses annually and also routine general health checks by school doctors during school years 1, 5, and 8 (at ages 7, 11, and 14 years) regardless of previously identified health risks.…”

“… 13 In our previous study, however, Finnish school doctors undertook actions in four-fifths of the health checks. 14 …”