Centre for Disability and Rehabilitation Studies

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Browsing Centre for Disability and Rehabilitation Studies by Author "Bennie Josephus, Theron"

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    An exploration of the need for lower limb prosthetic protocols in the South African private healthcare sector
    (Stellenbosch : Stellenbosch University, 2024-03-01) Bennie Josephus, Theron; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH SUMMARY: Background: Protocols are informed by evidence and provide guidance during prosthetic component selection and clinical intervention. They help to optimise patient care. If protocols are comprehensive and implemented effectively, they can enhance the quality and consistency of care to prosthetic users. Study aim: To explore and describe the need for a lower limb prosthetic prescription protocol in the private healthcare sector in South Africa. Objectives: ● To critically evaluate existing lower limb prosthetic management frameworks, protocolsand policy in the South African private healthcare sector. ● To explore the experience of lower limb prosthetic users in accessing prosthetic servicesin the private healthcare sector in South Africa. ● To explore perceptions of key informants on the need for lower limb prosthetic protocolsin the South African private healthcare sector. Method: A case study design was used to explore three cases i.e. the Road Accident Fund, Workmen’s Compensation Fund and the Council of Medical Schemes. Data was collected from documents, prosthetic users and key informants. Lower limb prosthetic prescription guidelines; protocols; regulatory frameworks; and policy were sourced and quantitatively evaluated according to the six domains of the Agree II instrument. Seventeen lower limb prosthetic users (beneficiaries from the three cases) sampled through deviant purposive sampling; and seven key informants sampled through expert purposive sampling, participated in online semi-structured interviews. This qualitative data was analysed through inductive thematic analysis. Findings: The AGREE II tool showed that across cases the ‘scope and purpose’ domain scored the highest at 50% (WCA), 47.2% (CMS) and 22.2% (RAF). ‘Editorial independence’ scored 0% for all three cases. Other challenging domains were ‘applicability’ with scores of 16.6%, 6.3% and 6.3% and ‘rigour of development’ (7.5%; 30%; 0%). Four cross case themes emerged: ● Prosthesis as functional enabler. The prosthesis restored mobility, normality and qualityof life. A need for a second prosthesis and advanced components was expressed. ● Prosthetic processes and protocol. Users were dissatisfied and frustrated due to longwaiting times, complex and unclear processes. ● Pre and post prosthetic rehabilitation. Access to rehabilitation services were challenging. ● Role of Certified Prosthetist and Orthotist (CPO). The CPO often provided prosthetic userswith guidance to navigate funder systems and secure funding for prosthetic care. Four further themes emerged from key informant interviews: ● Protocol availability and necessity. There was a need for a protocol. ● Purpose of the protocol. A protocol can support equity, ethical and transparent services,appropriate clinical prescription, fair reimbursement and better access to prostheticservices and rehabilitation. ● Protocol development requirements. Collaboration, facilitated by an independent body,should underscore the development of an evidence-based protocol. ● A Representative regulatory body is needed. Conclusion: A protocol is needed to guide prosthetic service delivery in the South African private healthcare sector. It should provide a set standard and transparency. The protocol should be evidence based and formulated by all relevant stakeholders to increase adoption. A protocol can facilitate optimum clinical care, equity, rehabilitation, fair reimbursement as well as enhancing user satisfaction with funder, device and services.