MJA Editor's Choice: consumer engagement is essential for policy success

In the April issue of the MJA, Quek at al provide structured recommendations regarding reducing medication burden in older adults. The consensus guideline was originally published by University of Western Australia in 2025 and is the result of a collaborative partnership between consumers, carers, health care professionals and researchers.

Identifying and deprescribing medications that may be inappropriate or are no longer aligned with a person’s medical conditions, treatment goals, life expectancy, or which carry unacceptable side effects, are important in terms of reducing the cumulative medication burden and the risk of adverse drug events and falls. Additional benefits may include lower costs, for both patients and the health system and simplified regimens. These guidelines are intended for all healthcare professionals involved in prescribing, dispensing or administering medicines to older people, and aim to bridge the gap from deprescribing research to practice.

While deprescribing is generally well accepted by older people if recommended by a trusted clinician, many also regard their medicines as essential, even when experiencing side effects. As an example, a patient may be reluctant to reduce or cease a medication, perhaps because they consider their condition serious, or have had a bad withdrawal experience in the past. In addition, individual tolerance to a range of side effects can vary.  A patient with mild heart failure on a diuretic but who has urinary incontinence impacting quality of life is an example of the need for patient-centred care and an individualised tailored approach.  And of course, there can always be the back-up plan that the medication can always be started again if needed.

An important strength of these guidelines is the meaningful involvement of consumers and carers with lived experience, alongside multidisciplinary clinical expertise.  Together, this collaboration offers an integrated, evidence-informed, and consumer-focused framework to support more proactive, person-centred care, as outlined in the recent National Consumer Engagement Strategy for  Health and Wellbeing.  Consumers provide crucial insights that might be missed in academic literature searches, such as practical barriers to care or quality-of-life trade-offs, and help to fashion guidelines that are more practical, meaningful and implementable. In essence, such co-design helps to ensure that the plan on paper will actually work in practice.

In their study, Quek et al also found that health professionals generally viewed deprescribing as beneficial, but its implementation is often hindered by time constraints and other factors such as limited knowledge or resources to initiate deprescribing, and reluctance to stop medicines prescribed by others.  These efforts recognise that medication regimens in later life are often complex, dynamic, and influenced by changing goals of care.

At the same time, system-level changes and reforms such as Australia’s 60-day dispensing policy are reshaping how medicines are accessed and managed.  

Until recently, the usual 30-day dispensing cycle has impacted people who find it difficult to leave their homes, live remotely, or who are under financial stress. Intended for Australians with chronic, stable health conditions, the 60-day dispensing rule allows patients to get twice the medication for the price of a single prescription and is available for more than 300 medications. This reform has relevance for older adults, including those with limited mobility or financial constraints.

However, as Wang et al. report in the April issue of the MJA, uptake has been modest. In their mixed methods study, which assessed the uptake of this new prescribing model for antihypertensive medications, they found that only 21% of antihypertensive prescriptions were for 60-day dispensing, 20 months after the introduction of the new policy. Nevertheless, the estimated cost savings for all patients were not insignificant- amounting to approximately $65 million during the study period.

Their qualitative findings suggest multiple barriers to uptake; For general practitioners this included difficulty keeping track of which medicines qualified, navigating PBS safety and finding it cumbersome to prescribe 60-day medicines with their prescribing software. Pharmacists identified barriers including incorrect dispensing and stock shortages in their pharmacy.

Together, these studies demonstrate that optimising medication use, especially in older adults, requires both person-centred guidance and systems that support its delivery.  Whilst deprescribing and policy reforms such as 60-day dispensing represent important strategies, they will fall short unless they are usable in everyday clinical practice. Bridging the gap between evidence, policy, and implementation remains one of the ongoing challenges in health care. Shared knowledge and collaboration between stakeholders can help to close that gap.

Read the latest issue of the Medical Journal of Australia.

Alison Williams is a Deputy Medical Editor with the Medical Journal of Australia.