How to Improve Medication Adherence in Community Pharmacy

You dispensed the statin twelve times last year for one patient and four times for another with the same diagnosis, the same prescriber and the same co-payment. Nothing in the dispensing record explains the gap. The medicine worked in both cases. Only one of them took it.

In short: roughly half of patients on long-term therapy do not take it as prescribed, and the reasons are practical far more often than they are stubborn. The pharmacy interventions that work start by finding out which patients are falling behind, then asking why before prescribing a solution.

How many patients take their medicines as prescribed?

The most-cited figure here is more than twenty years old and has not been overturned. The World Health Organization found that in developed countries, adherence among patients suffering chronic diseases averages only 50 percent, and is lower again in developing countries.

That is not a fringe subgroup. It is half of every chronic therapy your dispensary supplies.

The cost follows. An Australian study estimated the national cost of medication non-adherence across hypertension, dyslipidaemia and depression at 10.4 billion Australian dollars in 2018, approximately $517 per adult. Three conditions, one country, one year.

The same study modelled what changed after patients enrolled in a community pharmacy-led adherence intervention. Non-adherence costs per adult fell by $95, which the authors estimated at $1.9 billion in annual savings to the Australian health system and patients. That is a modelled figure from one intervention, so treat it as an indication of scale rather than a guarantee. The direction is the useful part: community pharmacy is where this problem is most cheaply addressed.

First, know what adherence actually means

Medication adherence is the extent to which a patient takes a medicine as agreed with their prescriber. It is not a personality assessment. It has a definition you can measure.

Research generally uses proportion of days covered, or PDC, calculated from dispensing records. A PDC of 80 percent or above is treated as adequate adherence to a chronic medicine. That threshold is a convention across the research literature, not a regulated standard.

The calculation is simple. A patient with a 30 day supply dispensed every 30 days has full coverage. One collecting the same supply every 45 days is covered two thirds of the time.

The practical value is that you can calculate it from data you already hold. Your dispensing history is also an adherence dataset.

Why patients stop

Before choosing an intervention, separate the causes. They call for genuinely different responses.

Cause	What it looks like	What helps
Complexity	Multiple medicines, several dose times, frequent changes	Dose administration aids, regimen simplification
Forgetting	Refills drift later each cycle, no other pattern	Reminders, synchronised refill dates
Practical access	Missed pickups, transport or mobility issues, distance	Delivery, repeat management
Side effects	Stops abruptly, often soon after initiation	Early follow-up call, prescriber referral
Belief	Feels well, doubts the medicine is needed	Counselling on why the medicine is silent by design
Cost	Partial fills, asks which one to skip	Review for cheaper equivalents, safety net awareness

The common failure is treating every case as forgetting. A patient who stopped because of muscle pain does not need a reminder, and one who cannot afford three medicines does not need a blister pack. Ask before you fix.

Five things a pharmacy can do

1. Find the patients before they disappear

Run a monthly list of chronic-medicine patients whose last supply is overdue. Most dispensing systems can produce it. Start with the therapeutic areas where a lapse matters most, such as cardiovascular, respiratory and mental health.

This one change converts adherence work from opportunistic to systematic. You stop waiting for the patient to appear and start noticing when they do not.

2. Ask an open question

The cheapest first move costs nothing. Ask how the patient is going with the medicine, then wait. Closed questions produce reassurance. Open ones produce the actual reason, which is what determines the right intervention.

3. Use the funded programs properly

Australia funds several of these services through community pharmacy. The Pharmacy Programs Administrator runs Dose Administration Aids, Indigenous Dose Administration Aids, Staged Supply and Opioid Dependence Treatment as adherence programs. MedsCheck and Diabetes MedsCheck sit alongside them as medication management programs. The DAA program alone pays $6.17 per patient per service, capped at 90 services a week.

These are worth using deliberately rather than by default. Whether the economics work for your pharmacy is a separate question, which we work through in are dose administration aids worth it.

4. Remove the practical barriers

Some non-adherence is purely logistical, and logistics are solvable. Synchronising refill dates so a patient makes one trip instead of four removes friction for anyone managing multiple medicines.

Delivery does the same for patients who cannot easily get in. In beta call data from one Australian pharmacy, delivery requests were the single largest category of captured requests at 40.2 percent. That demand arrives whether or not the service is offered. We covered that in should your pharmacy offer delivery.

5. Follow up soon after initiation

In practice, discontinuation tends to cluster early, often in the first weeks, and often over a side effect the patient never mentioned. A short call a fortnight after starting a new chronic medicine catches that window. It is also the point where a referral back to the prescriber changes the outcome rather than documenting it.

Measuring whether any of it worked

Pick one cohort, one therapeutic area, and one number. Calculate the proportion of that cohort at or above 80 percent PDC today, run your intervention for six months, then calculate it again.

Without a baseline you will not be able to tell improvement from seasonality, and adherence programs are easy to feel good about and hard to prove. Choose the number before you start.

Where Krepko fits

Most of the work above is contact work: noticing a patient is overdue, calling to ask why, following up after initiation, arranging delivery. That contact competes directly with the dispensary bench for the same staff hours, and the bench usually wins.

Emily is our AI voice agent for Australian pharmacies. She answers routine calls using your pharmacy’s real data, and passes anything clinical or complex to a pharmacist. The relevance to adherence is straightforward: when routine inbound calls stop landing on your team, the outbound follow-up calls stop being the first thing cut.

Adherence follow-up is clinical work, and it stays with your pharmacists. What we can change is how much of their day is spent on calls that never needed them. For the wider service mix, see alternative revenue streams for independent pharmacy. You can see how Emily works at krepko.com.au.