Prosthetic Provision in Other States
20
1 How the other half lives: Prosthetic provision in other states Anna Frazer Prosthetist Hunter Prosthetics & Orthotics Service June 16 th 2006
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Transcript of Prosthetic Provision in Other States
1
How the other half lives:Prosthetic provision in other states
Anna FrazerProsthetist
Hunter Prosthetics & Orthotics Service
June 16th 2006
Why different models?
Large land mass, small population
Rehabilitation services
– Affected by geography
– Funding
– Affected by education facilities
“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
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
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
Queensland
Funding
– Inpatient• Hospital based treatment covered
• Mechanical interim prostheses not funded
– Outpatient• QALS funds definitive prostheses with limits
• Assistive devices provided under MASS
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
Western Australia
Funding
– Inpatient• Hospitals fund all treatments except prosthetic care
• WALSA funds interim prostheses
– Outpatient• WALSA funds definitive prostheses
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
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
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
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
Victoria
Team
– 9 public prosthetic rehab facilities using MD teams
– Prosthetists fitting mechanical interim prostheses
– Patients travel to regional centres for prosthetic care
Tasmania
Funding
– Inpatient• Hospitals provide funds for bed days but OPST holds
budget for all P&O 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
Tasmania
Team
– 3 amputee rehabilitation facilities
– On and off-site prosthetists attend rehab wards
– Prosthetists fit RRDs in recovery and provide follow-up care
ACT
Funding
– Inpatient• Hospital responsibility for interims
– Outpatient• ACTALS, similar system to NSW
Team
1 rehab facility
2 clinics
South Australia
Funding
– Inpatient
– Outpatient
Team
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
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
Differences to note…
Summary
Different models
Different timing
Different funding
Different staffing
… different outcomes?
