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