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?