AB0856-PARE A paradigm shift, transition from nonprofit to profit for ra-instructors
Authors: R. Greiff
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> In 1988 the University of Texas, Southwestern Medical Center (UTSW) started "Arthritis Educator Program". The purpose was to improve rheumatology training of future physicians using patients with rheumatoid arthritis. However the program struck so well that it soon came to be directed at general practitioners, nurses, occupational therapists and others. When it was introduced in Sweden we called it RA-Instruktörer - RA-Instructor training program. An RA-Instructor is a person with rheumatoid arthritis who is trained to teach health-care staff how to conduct a joint investigation provides information on typical RA symptoms and share their patient experience. From 1999 the Swedish Rheumatism Association (SRA) and pharmaceutical companies collaborated running the RA-Instructor program. 2010-2011 the companies announced that they wanted to stop funding RA-Instructors. SRA sought to find new ways of financing the program. During this process great uncertainty of course arose and different messages were sent out to all interested. Before everything was actually sorted out, messages about closure of the RA-Instructor training program were released. In the spring of 2012 the SRA handed over the business to its training company Reuma Development limited company (RD). <h3>Objectives</h3> The first objective for RD was fire extinguishing, we quickly informed all involved that the RA-Instructor program will continue in the autumn 2012. This meant email messages to everyone, a lot of telephone calls and to constantly reaffirm that we would continue with the same RA-Instructors as before. <h3>Methods</h3> We contacted all previous customers in order to sign contracts with medical education providers, physical therapist education, primary health care centers etc. At the same time we organized schedules, fee reports, evaluation reports and procedures etc with our RA-Instructors. We spread the message through our website www.reumautveckling.org with the title "Knowledge which makes difference". We updated and printed a new edition of our educational material "Manual in hand and wrist examination in RA" with the latest scientific knowledge about RA. <h3>Results</h3> After an intensive process, we managed to reach an agreement with all but one former customer to continue with the RA-Instructor training in the autumn and they accepted higher costs for the training program. Until now we have completed over 90 training sessions, it has been done for medical students, physical therapist education, occupational training, foot care education and primary health care etc. We have so far reached over 450 students and receive a very high score in their evaluation. <h3>Conclusions</h3> The primary conclusion is of course "We made it" e.g. we managed to continue with the RA-Instructors training program. But we cannot yet claim that we have achieved a complete paradigm shift, transition from nonprofit to profit for RA-Instructors. Our price for the training is too low. In order to achieve an enduring profit we will need to raise our price with at least 30% within 2 year. We need to build a surplus it is the only way to finance training of new RA-Instructors and skills development of those we have. To realize this rise of our price is a challenge in the nearest future and we also need to keep up the same high score in the evaluation from students and customers. On a long term basis we need to double the customer list, complete over 250-350 training sessions per year and simplify and reduce administrative costs. <h3>Disclosure of Interest</h3> None Declared