How the other half lives: Prosthetic provision in other states

1
How the other half livesProsthetic provision in
other states

• Anna Frazer
• Prosthetist
• Hunter Prosthetics Orthotics Service
• June 16th 2006

2
Why different models?

• Large land mass, small population
• Rehabilitation services
• Affected by geography
• Funding
• Affected by education facilities

3
Best Practice

• Resources detailing guidelines for Amputee
  rehabilitation
• Anne Caudle Centre, Bendigo, Best Practice guide
  1994
• 2005 Consensus conference- American Orthotic
  Prosthetic Association
• NSW review of amputee services 2004
• BAPO, APA, AOPA
• No consensus

4
New South Wales

• Funding
• Inpatient
• Wound care, surgery, and treatments, covered by
  bed day funds
• Outpatient
• ALS covers prosthetic needs with limits on
  funding for components
• List provided of approved components, many
  restrictions
• Assistive devices may be covered by PADP

5
New South Wales

• Team involvement
• 3 public facilities using prosthetists in
  rehabilitation
• Physiotherapists providing primary prosthetic
  care and gait training
• Prosthetists travel to regional areas for clinics

6
Queensland

• Funding
• Inpatient
• Hospital based treatment covered
• Mechanical interim prostheses not funded
• Outpatient
• QALS funds definitive prostheses with limits
• Assistive devices provided under MASS

7
Queensland

• Team
• Varies according to location
• 3 public facilities provide in-house prosthetic
  rehab
• Rehabilitation Consultant not involved until the
  end of interim treatment
• Prosthetists travel to rural areas for clinics

8
Western Australia

• Funding
• Inpatient
• Hospitals fund all treatments except prosthetic
  care
• WALSA funds interim prostheses
• Outpatient
• WALSA funds definitive prostheses

9
Western Australia

• Team
• 1 amputee rehabilitation consultant for all of WA
• 1 public prosthetic rehab facility
• 2 off-site private providers attend 2 rehab
  facilities
• Physiotherapists fit and maintain RRDs
• 5 prosthetists supplying all definitive limbs

10
Northern Territory

• Funding
• Inpatient
• Hospital covers all interim prosthetic care
• 1st definitive also covered by hospital funds
• Outpatient
• NT ALS funds definitive services
• Often provides funds for spare limbs due to large
  distances

11
Northern Territory

• Team
• 1 amputee rehab facility in Darwin
• 1prosthetic facility, at least 2 prosthetists
• Outreach services provided to other territory
  rehab facilities
• 1 private company from Sydney attends 4 x year
• No RRDs being fitted

12
Victoria

• Funding
• Inpatient
• Hospital funding covers all treatments including
  prosthetics and orthotics- WEIS funding
• Amputees classified as highest level funding
• Outpatient
• VALP funds prostheses and outpatient rehab if
  required

13
Victoria

• Team
• 9 public prosthetic rehab facilities using MD
  teams
• Prosthetists fitting mechanical interim
  prostheses
• Patients travel to regional centres for
  prosthetic care

14
Tasmania

• Funding
• Inpatient
• Hospitals provide funds for bed days but OPST
  holds budget for all PO services in Tasmania
• Interim prostheses from OPST budget with limits
  preset to prevent exceeding budget
• Outpatient
• Same budget as interim prosthetics
• Patients pay for componentry above certain limit

15
Tasmania

• Team
• 3 amputee rehabilitation facilities
• On and off-site prosthetists attend rehab wards
• Prosthetists fit RRDs in recovery and provide
  follow-up care

16
ACT

• Funding
• Inpatient
• Hospital responsibility for interims
• Outpatient
• ACTALS, similar system to NSW
• Team
• 1 rehab facility
• 2 clinics

17
South Australia

• Funding
• Inpatient
• Outpatient
• Team

18
Differences to note

• Acquittal methods
• Difficulty in getting some patients to return for
  acquittal appointments, especially in rural areas
• TAS provides peer review acquittal
• QLD investigating allowing prosthetists to
  prescribe replacement limbs
• Rural service difficulties
• QLD may be investigating training rural staff in
  CAD-CAM systems

19
Differences to note

• Therapeutic Goods Act
• Affects all prostheses provided nationwide
• Regulations regarding
• use of second-hand componentry
• quality programs
• patient safety
• post market surveillance

20
Summary

• Different models
• Different timing
• Different funding
• Different staffing
• different outcomes?