Frossard Laurent, Merlo Gregory, Quincey Tanya, Burkett Brendan, Berg Debra
Queensland University of Technology, Brisbane, QLD, Australia.
University of the Sunshine Coast, Maroochydore, QLD, Australia.
Pharmacoecon Open. 2017 Dec;1(4):301-314. doi: 10.1007/s41669-017-0032-5.
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.
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.
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.
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).
This study provides a working plan to stakeholders developing and implementing policies around the care of individuals choosing osseointegration for BAPs.
政府组织在调整程序方面面临挑战，这些程序旨在为截肢消费者提供公平援助，使他们在骨锚式假肢（BAP）的新型骨整合固定装置和接受腔悬吊式假肢之间做出选择。
本研究的目的是（1）提出一个关注假肢护理任务、文件和成本的程序，（2）分享观察到的实施障碍和促进因素。
本研究旨在制定一项提供BAP的政府程序，设计为一项行动研究。总共考虑了18名仅由昆士兰州组织全额资助的经股截肢者。
该程序于2011年1月至2015年6月制定，包括七个涉及治疗期间固定费用的流程和五个规范持续假肢护理费用的流程。假肢护理在康复期间需要22小时的人工，每位患者相当于3300澳元。假肢技师分别将64%和36%的时间用于假肢护理和其他活动。该程序需要对假肢技师的执业范围、康复期间假肢肢体的资金以及微处理器控制的假肢膝关节的分配进行调整。分别约41% (7) 和59% (10) 的障碍在政府控制范围内（例如简化系统流程、持续评估这一复杂程序）或之外（例如利益相关者的早期和持续协商、缺乏明确的康复计划），约89% (17) 的促进因素在政府控制范围内（例如调整现有流程）。
本研究为利益相关者制定和实施围绕为选择骨整合BAP的个体提供护理的政策提供了一个工作计划。
