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

Abstract Background In Finland, most school doctor resources are dedicated to general health checks at predetermined ages in addition to annual health checks by school nurses. This study explored the association of school doctor interventions with the doctor- and the parent-evaluated benefit of the appointment. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades one and five, aged seven and eleven years, respectively, from 21 Finnish elementary schools in four municipalities. Doctors routinely examined all children accompanied by parents and reported their interventions. They estimated the benefit/harm of the appointment according to predetermined criteria, whereas parents provided their subjective perceptions. Multilevel logistic regression was used for comparisons. Results The doctors conducted interventions for 78% of the participating 1013 children. The interventions included: referrals to secondary care (5%), laboratory tests or medical imaging (8%), prescriptions (10%), referrals to experts (13%), instructions/significant discussions (60%), and additional appointments (17%). The doctors and parents found 41% and 83% of the health checks beneficial, respectively. The doctors reported 52% and the parents 87% of the appointments with interventions beneficial. The doctors considered none and the parents 68% of the appointments with no interventions beneficial. All interventions were associated with the doctor-evaluated benefit. All interventions except referrals to secondary care, guidance to experts, and additional appointments were associated with the parent-evaluated benefit. Conclusions Parents valued immediate help and testing from the doctor instead of referrals to other experts or follow-up. Doctors mostly valued the appointments that required their expertise. These findings support the evidence for directing school doctor resources to the children who need doctor's expertise. Key messages Parents could benefit from information when school doctor’s expertise is pivotal. Doctors are frequently not essential in general health checks of elementary school children. This supports the evidence for focusing school doctor resources to the children who need them most.