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Interview: Medication non-adherence is a growing problem (Includes interview)

As well as putting patients at risk, non-adherence to medication for chronic illnesses is costing the U.S. healthcare system around $310 billion a year in additional costs. To combat this issue, Danish startup Klikkit has designed the world’s first ‘smart button’ that trains a patient’s brain to learn and remember a positive behavior.

The portable, color-coded Klikkit button, when paired with the patient’s mobile device, uses a behavioral science method known as the “habit loop.” The patient sets a goal with the free app, then attaches the smart button to any object associated with that behavior, such as a pill bottle.

To explain how the technology works, Klikkit CEO Cristiano Cairo spoke with Digital Journal.

Klikkit CEO Cristiano Cairo.

Klikkit CEO Cristiano Cairo.
Cristiano Cairo

Digital Journal: What is the extent of medicine non-adherence?

Cristiano Cairo: Research shows that medication non-adherence has become an increasingly evident problem in recent years. The New England Health Care Institute estimates that in more than 50 percent of Americans have trouble taking to their medication as prescribed. When you consider that half of Americans aren’t taking their medications properly, it’s clear that we have to start thinking about this problem in a different way.

DJ: What are the risks of medical non-adherence for patients?

Cairo: The risks may surprise you. The New England Journal of Medicine reported that in the U.S., non-adherence is the cause up to 69 percent of hospitalizations, and 125,000 preventable deaths per year. People often underestimate the importance of following their medical treatment plan as instructed by their physician. Patients affected by chronic conditions (and associated comorbidities) tend to underestimate the risks involved in with non-adherence. It’s hugely important for us to take ownership of our conditions.

DJ: Are any types of medical conditions more serious for patients?

Cairo: In terms of adherence, it’s important to consider this question from the patient perspective, as the patient is the most integral cog in the wheel. From the point of view of a patient, all chronic conditions have a high impact on quality of life. Building out a daily routine to take care of all chronic conditions should be the goal.

From a clinical perspective, some conditions are more severe than others, but I believe we need to focus on the outlook of the patient when we’re addressing the adherence issue.

DJ: How about the overall impact of non-adherence on the healthcare system?

Cairo: We know that non-adherence accounts for an estimated average of $200 billion in annual healthcare costs. The Annals of Internal Medicine estimated last year that a lack of adherence causes nearly 125,000 deaths, 10 percent of hospitalizations and costs the already strained healthcare system between $100–$289 billion a year. These deaths are largely preventable, merely by taking the prescribed medications as directed.

DJ: Please explain how the Klikkit button came about?

Cairo: Klikkit was designed and developed in LEO Innovation Lab, a health tech incubator in Denmark focused on improving the life of people with chronic conditions through digital innovation. We wanted to build a solution that was easy to use, discreet, and didn’t create any additional stress or treatment burden for the people we wanted to help.

Our vision was to ensure the Klikkit system had a universal application, so we could help as many people as possible. We didn’t want to build something that was limited to a specific treatment type; patients with chronic diseases often need more than just pills. We came up with the idea of a button that can be placed where it is most convenient, it can be used for a variety of applications, including medications, and it doesn’t project the image of medical device for sick people. We tested it and people loved it: user feedback shows that it’s fun to use and it gets the job done.

DJ: What is the science behind the Klikkit button?

We involved renowned behavioral scientist Pelle Guldborg Hansen early on in the development process. The Klikkit system is built upon the foundations of a core theory within behavioral science called the “habit loop.”

The habit loop is an evidence-based method proven to strengthen habits over time. In essence, the physical presence of the button, combined with sound alerts and a light function, work as physical cues, triggering an action. Pressing the button then acts as a “cognitive closure,” an immediate reward for the user when having completed a task.

DJ: What has the response been from the medical profession?

Cairo: While we are still in the process of completing our pilots with our medical partners, we can say that we have received overwhelming interest in the solution. Its main value lies in its simplicity and versatility. Treating physicians and nurses immediately see why Klikkit can solve the non-adherence problem and, with their expertise, they are helping us to find multiple use cases for its application.

Furthermore, we have conducted a scientific study with Klikkit that showed a significant improvement in efficacy of a treatment regimen based on the physician’s and patient’s evaluation. In our study, 71% of the patients expressed that they believed that Klikkit would help them follow their treatment plan better. The data has been accepted for publication at ISAD 2018, April 11-13, 2018 in Utrecht, The Netherlands.

DJ: Have you asked consumers what they think?

Cairo: In November of last year we launched a small pilot campaign in England, targeting the general public. It was very inspiring to read all comments on how Klikkit can help people making positive habits stick. People were positive about how Klikkit can be used for medication adherence but also to reinforce a healthier lifestyle, from taking supplements, to drinking more water at work, taking a walk or simply taking a moment to relax.

DJ: Why did you decide to launch a Kickstarter campaign?

Cairo: We are in the process of spinning Klikkit out from the LEO Innovation Lab incubator and building out more of a U.S. presence. We see Kickstarter as an opportunity to collect the initial funding we need and also as a way to present our exciting solution to the world.

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Written By

Dr. Tim Sandle is Digital Journal's Editor-at-Large for science news. Tim specializes in science, technology, environmental, business, and health journalism. He is additionally a practising microbiologist; and an author. He is also interested in history, politics and current affairs.

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