This paper reports the results of a longitudinal study of 688 individuals with arthritis regarding their medication perceptions, decisions and use. The goal of this paper is to examine the applicability of the Concordance Framework for describing the needs and decisions of these individuals for managing their arthritis. The sample was enrolled at 3 clinics during their clinic visit (a university based clinic, a large private clinic, and veterans administration public clinic). The participation rate was 90%. Data collection included face to face interviews at each visit, telephone interviews, medical record abstraction, community pharmacy patient profiles. These data are linked by patient ID at the time of each clinic visit, allowing triangulation of data for a single time period. To examine the appropriateness of the Concordance Framework, this paper presents data which describe the active role of the patient. Individuals' attempts to evaluate their regimens' benefits and side effects will be presented in relation to their regimen decision making across a 2 year period. Particular attention is paid to their use of over-the-counter medications reclassified from prescription drug status.

There is an urgent need to examine approaches to aid patient-provider partnerships to manage complex regimens. Our study documented that over 55% of patients with osteoarthritis or rheumatoid arthritis had 8 or more medications in their total regimen for arthritis and their comorbidities. Findings suggest that providers and patients with arthritis are constantly calibrating the patient's regimen. Of the patients followed longitudinally for 2 years, only 19% had unchanged medication regimens in any given 6 month period. At the end of 2 years, none of the patients had not had the physician order a change in their medication regimens. As well, we found that 3/4 of the sample were engaged in self-care for their arthritis. About half of the individuals reported not speaking with their provider regarding these self-care decisions. Further, providers encouraged a substantial number of patients to calibrate their own prescription medications such as steroids based on the side effects and benefits experienced between visits. Face to face and telephone patient interviews across the study documented that about 30% of patients reported medication side effects at each 6 month visit. Thirty-one percent of the patients reported that they thought about changing their regimen in the past month. Logistic regression analyses were conducted to examine factors related to individuals' deviation from prescribed regimens. The reported number and seriousness of side effects was the best predictor with perceived benefits the second most important factor. Hence it appears that individuals are actively evaluating their regimens and seeking the best balance of positive and negative regimen effects. Using these data this paper will apply the Concordance Framework and explore its implications for individuals' partnerships with their providers.