Development of a Procedure for the Government Provision of Bone-Anchored Prosthesis Using Osseointegration in Australia

BACKGROUND: Governmental organizations are facing challenges in adjusting procedures providing equitable assistance to consumers with amputation choosing newly available osseointegrated fixations for bone-anchored prostheses (BAPs) over socket-suspended prostheses. OBJECTIVES: The aims of this study were to (1) present a procedure focusing on tasks, documents and costs of prosthetic care, and (2) share observed obstacles and facilitators to implementation. METHODS: This research aimed at developing a governmental procedure for the provision of BAPs was designed as an action research study. A total of 18 individuals with transfemoral amputation solely funded by a Queensland State organization were considered. RESULTS: The procedure, developed between January 2011 and June 2015, included seven processes involving fixed expenses during treatment and five processes regulating ongoing prosthetic care expenses. Prosthetic care required 22 h of labor, corresponding to AUD$3300 per patient, during rehabilitation. Prosthetists spend 64 and 36% of their time focusing on prosthetic care and other activities, respectively. The procedure required adjustments related to the scope of practice of prosthetists, funding of prosthetic limbs during rehabilitation, and allocation of microprocessor-controlled prosthetic knees. Approximately 41% (7) and 59% (10) of obstacles were within (e.g. streamlining systematic processes, sustaining evaluation of this complex procedure) or outside (e.g. early and consistent consultations of stakeholders, lack of a definitive rehabilitation program) governmental control, respectively, and approximately 89% (17) of the facilitators were within governmental control (e.g. adapting existing processes). CONCLUSION: This study provides a working plan to stakeholders developing and implementing policies around the care of individuals choosing osseointegration for BAPs.