An Inter- and Multi-disciplinary Team Approach Organized with Multiple Institutions for Cleft Lip and Palate Care in a Rural Area

[Purpose] The team approach is essential for favorable outcomes in the management of patients with cleft lip and palate. In a large rural area in and around Nagano prefecture, an inter- and multi-disciplinary team approach organized with multiple institutions has been developed utilizing networking to treat cleft patients. This paper describes the steps and problems in developing our multi-institutional team after more than 10 years of practice.<br>[Methods] Patients were operated on in a central hospital at several year intervals. Some divisions, such as speech therapy, orthodontic treatment, and ear-nose-and -throat treatment, which require frequent visits, were decentralized and patients could receive treatment at local clinics. Several networking tools, including a small conference, annual local workshop, mailing list, pocketbook, and homepage, have been used for over ten years to maintain good connections among various specialists of the team.<br>[Results] 1067 patients with cleft lip and palate have been treated by our multi-institutional team. All patients could visit outpatient clinics within one hour to be treated by a speech pathologist, an orthodontic dentist or an ENT doctor. After over 10 years of working as a team using those networking tools, mutual understanding and common views could be established among team members. The small conference and pocketbook continue to be used. However, it took time and effort to maintain some networking tools. The local workshops were simplified. The mailing list was used under limited situations. The homepage of the team was only used to educate patients and their families.<br>[Conclusion] Simple networking tools are required for keeping good communication and confidence among members of the multi-institutional team. After establishing confidence, the multi-institutional team can assure patients of favorable and adequate medical care only with brief communications among members of the team.