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

Kirsi Nikander; Silja Kosola; Tero Vahlberg; Minna Kaila; Elina Hermanson

doi:10.1136/bmjpo-2021-001394

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

BMJ Paediatr Open. 2022 Feb;6(1):e001394. doi: 10.1136/bmjpo-2021-001394.

Authors

Kirsi Nikander^{1

2

3}, Silja Kosola⁴, Tero Vahlberg⁵, Minna Kaila⁶, Elina Hermanson⁷

Affiliations

¹ Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland kirsi.nikander@iki.fi.
² School and Student Healthcare, Department of Social Services and Healthcare, City of Helsinki, Helsinki, Finland.
³ Doctoral School in Health Sciences, Doctoral Program in Population Health, University of Helsinki, Helsinki, Finland.
⁴ Pediatric Research Center, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁵ Faculty of Medicine, Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland.
⁶ Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁷ Pikkujätti Medical Center for Children and Youth, Helsinki, Finland.

Abstract

Background: The 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.

Methods: Between 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.

Results: Doctors 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.

Conclusions: Doctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor.

Trial registration number: NCT03178331.

Keywords: health services research.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Appointments and Schedules
Child
Humans
Parents
Physicians*
Referral and Consultation
Schools*

Associated data

ClinicalTrials.gov/NCT03178331