How the other half lives: Prosthetic provision in other states

1. How the other half lives:Prosthetic 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 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

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?