Development of a procedure for the government provision of bone-anchored prosthesis using osseointegration in Australia

<b>Background</b>\ud \ud Governmental organizations are facing challenges in adjusting procedures providing equitable assistance to consumers with amputation choosing newly available osseointegrated fixations for bone-anchored prostheses over socket-suspended prostheses. \ud \ud <b>Objectives</b>\ud \ud The objectives were <i>(1)</i> to present a procedure focusing on tasks, documents and costs of prosthetic care, and <i>(2)</i> to share observed obstacles and facilitators to implementation. \ud \ud <b>Methods</b>\ud \ud This research aiming at developing a governmental procedure for the provision of bone-anchored prostheses was designed as an action-research study. A total of 18 individuals with transfemoral amputation solely funded by a Queensland State organization were considered. \ud \ud <b>Results</b>\ud \ud \ud The procedure developed between 01/2011 and 06/2015 included seven processes involving fixed expenses during the treatment and five processes regulating ongoing prosthetic care expenses. Prosthetic care required 22 hours of labor corresponding to AUD$3,300 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 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 the 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. Approximately, 89% (17) of the facilitators were within governmental control (e.g., adapting existing processes). \ud \ud <b>Conclusion</b>\ud \ud This study provides a working plan to stakeholders developing and implementing policies around care of individuals choosing osseointegration for bone-anchored prostheses