TABLE 1.

SystemCHANGE™ and patient education interventions

Intervention steps	Items for the provider to discuss with the patient	Location/timing
SystemCHANGE™
1. Plan step: Introduction to SystemCHANGE™ and review of feedback from electronic medication self-monitoring report via MEMS report Set medication adherence goal Determining process owners Problem solving/medication adherence solution selection focusing on environmental changes Explore lifestyle routines and habits around medication taking	Overview of SystemCHANGE™ -challenges of medication taking (takes time, not your fault, should not have to try harder, medications should be in the right place at the right time, habits and routines are key to success), focus on routines and conducting small experiments to improve medication taking, review 4 steps of SystemCHANGE™, and discuss how RA will guide them through the process of improvement. What are your thoughts about your MEMS report? What is your medication adherence goal? Who are the important people in your medication taking process? What are your routines and habits around your morning and evening medication taking times? How do these routines and habits occur, one to the next, to either support or hinder medication taking? Where can you place your medication so your routines and habits around the desired medication taking time support medication taking?	40 min in person during home or clinic visit for Steps 1 and 2
2. Do step: Implement small experiment of medication adherence solution Storyboard	What possible solution, based on placing your medication in the right place so they are available at the right time, should be tested? If the patient cannot identify any possible solutions to test, depending upon their routines and habits around medication taking times, consider suggesting the following: setting the cell phone alarm; placing medications near coffee/tea pot, computer, toothbrush, car keys, coffee mug, pet’s medications, etc. If someone else “touches” the medication taking process, eg, obtaining or setting up the medications for the patient, they should be involved in selecting the solution to test. Where can you place your MEMS report so others can see your progress?
Check step: Track medication taking and timing with the MEMS Cap Act step: Evaluate how the change is working by reviewing the report	Do any adjustments need to be made to your MEMS report, eg, took medication out early to take later, refilled bottle, etc.? Is the implemented solution from Step 2 working to improve medication taking? What are you learning about your medication taking? If the original solution is not working what solution to improve medication taking would you like to try next?	10 min at months 1, 2, 3, 4, 5 over the telephone
Patient education
	Review “maintaining a healthy lifestyle after transplant” brochure	40 min in person during home or clinic visit
	Review one of the following brochures each month: Skin cancer risks in transplant recipients: know the facts What every patient needs to know about dental care Controlled GI side effects Diabetes after transplant Diet and exercise	10 min at months 1, 2, 3, 4, 5 over the telephone

MEMS, Medication Event Monitoring System.