Primary Care Physician Experience with Children with Oral Clefts in Three States

BACKGROUND: The experience of primary care physicians in Arkansas, Iowa, and New York treating children with oral clefts (OCs) was investigated, along with their knowledge and comfort caring for or referring these children.

METHODS: A mail survey was conducted with all primary care physicians in Iowa and Arkansas, and a random sample of 4000 physicians in New York, selected from the American Medical Association (AMA) Master File. The final dataset consisted of 1435 usable surveys. Outcome measures were experience and comfort providing care to or referring children with OC. Differences between states were tested using Pearson or Kruskal-Wallis chi-square tests, or F-tests for differences in means.

RESULTS: Two-thirds of respondents had provided care to a child with an OC since completing residency. Physicians were most comfortable providing routine care and much less comfortable providing counseling on cleft-related issues. Eighty percent had an organized cleft team to which they could refer. About two-thirds were very comfortable with the expertise available for surgical care, speech, and hearing; half were for dental care; only 40% were for behavioral or emotional counseling. Two-thirds were interested in continuing medical education (CME) on cleft care.

CONCLUSIONS: Primary care physicians in all three states had little experience with children with OCs. This limited experience poses significant barriers to care. Increased experience during training and CME opportunities could improve knowledge and comfort with providing OC-related care. Increasing knowledge of referral options for team care and other cleft-related services could also help physicians when caring for children with OCs.