1 How the other half lives: Prosthetic provision in other states Anna Frazer Prosthetist Hunter Prosthetics & Orthotics Service June 16 th 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 1 st 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?