Feasibility of the 15-STARS questionnaire for medication adherence optimization in community pharmacies: the Lithuanian pharmacists’ perspectives

Background. Community pharmacists provide patients with information about their treatments and can enhance medication adherence. The 15-STARS questionnaire is a validated self-report questionnaire detecting modifiable determinants of medication non-adherence and enabling community pharmacists to propose tailored adherence interventions to the patients1.
Purpose. This study aimed to test the feasibility of the 15-STARS questionnaire to tailor medication adherence during medication consultations from the Lithuanian community pharmacists’ perspectives.
Method. The 15-STARS questionnaire was translated from English to Lithuanian following the Preferred Methods for Translation and Dissemination of PCNE reports. The feasibility study was set as the first iteration in the plan-do-study-act action research model. Researchers designed the initial intervention version, which community pharmacists then delivered. Subsequently, the feasibility was discussed in focus groups with pharmacists delivering the intervention. To address feasibility, the acceptability domain as defined by Bowen et al.2 was the focus. The interview guide drew inspiration from a theoretical understanding of prospective and concurrent acceptability by Sekhon et al.3, addressing affective attitude, burden, ethicality, intervention coherence, and opportunity costs.
Findings. The intervention consisted of delivering the paper-based questionnaire to patients collecting medications for hypertension and type 2 diabetes. Patients completed the questionnaire while pharmacists prepared their prescription medications. Pharmacists then tailored their usual medication consultations based on patients’ answers. In total, 6 pharmacists from one community pharmacy in Vilnius delivered the intervention over a three-week period in February 2024 and subsequently participated in two focus groups. During the intervention, 45 patients were offered the 15-STARS questionnaire, of which 14 (31.1%) accepted. Pharmacists agreed on their responsibility to address medication adherence problems with patients pursuing prescription drugs. They thought that the 15-STARS questionnaire was an acceptable instrument, as it was easy to fill in, did not take extra time for patients, and did not distract pharmacists from other duties. However, pharmacists noticed variations in patients’ interest in engaging in unusual activities during pharmacy visits. After many patients refused the questionnaire, some pharmacists felt uncomfortable offering it. They suggested engaging only those patients who had multiple prescriptions and finding more natural than paper-based ways of questionnaire delivery.
Conclusion. From the Lithuanian pharmacists’ perspective, the 15-STARS questionnaire is an acceptable instrument to be introduced into pharmacy practice to target medication consultations to optimize medication adherence, preferably for polypharmacy patients. Further refinement of questionnaire delivery and understanding patients’ perspectives is necessary in subsequent iteration.