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

OBJECTIVE: To evaluate the association between the concerns of parents, teachers, and nurses regarding each child’s well-being and the school doctor actions conducted in routine general health checks. DESIGN: A blinded, observational study. Prior to the health check parents, teachers, and nurses completed questionnaires assessing their concerns. Doctors, blinded to the responses, routinely examined all children accompanied by parents and reported their actions after each health check. Multilevel logistic regression was used to analyse the association of the concerns with the actions. SETTING: 21 primary schools in four municipalities in Finland. PARTICIPANTS: Between August 2017 and August 2018, we randomly recruited 1341 children from grades 1 and 5, aged 7 and 11 years, respectively. OUTCOME MEASURES: Outcome measures were the respondents’ concerns and the school doctor actions. The extent of concerns was assessed on a five-point Likert scale. Concern refers to ‘Quite a lot or a great deal of concern’ by at least one respondent. The school doctor actions included 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. RESULTS: Altogether, respondents were concerned about 47.5% of children. The top three concerns comprised growth/and or physical symptoms (22.7%), emotions (16.2%), and concentration (15.1%). All concerns were associated with some type of school doctor action (ORs: 1.66–4.27, p≤0.05); but only concerns regarding growth and/or physical symptoms were associated with all actions. Almost all concerns were associated with referrals to other professionals (ORs: 1.80–4.52, p≤0.01); emotions had the strongest association OR 4.52 (95% CI 3.00 to 6.80, p<0.0001). CONCLUSIONS: Health checks by school doctors may lead to referrals of children to other professionals especially for children’s psychosocial problems. This should be considered when developing the roles, training, and multiprofessional collaboration of school health care professionals. TRIAL REGISTRATION: NCT03178331.