‘A joint effort’: stakeholders' perspectives of medication management reviews in Australian residential aged care

Objective: Residential Medication Management Review (RMMR) is a government-funded pharmacist-led service to address medication-related problems, such as polypharmacy, which are prevalent in aged care. Despite known benefits, concerns remain about the service's effective implementation to benefit residents. We aimed to explore stakeholders' perspectives of the service and identify challenges and improvement opportunities. Method: A qualitative study was conducted using individual interviews and focus groups with 21 stakeholders, including general practitioners (GPs), a nurse practitioner, registered nurses, pharmacists and consumers. Audio transcripts of the discussions were thematically analysed using inductive coding. Results: Seven interconnected themes were identified, highlighting complexities in RMMR implementation and its role in medication optimisation in aged care. Consumer participation was limited, with low awareness and engagement despite a strong desire for involvement. General practitioners played a central role, acting as both enablers and gatekeepers. Despite the recognised value of interdisciplinary collaboration, professional silos and communication gaps created tensions. Review quality varied, with resident-centred and contextualised recommendations seen as more impactful. Improved integration of digital systems was viewed as a key enabler, though existing systems were often fragmented. Workforce and funding constraints limited provider motivation and service delivery. Finally, RMMRs were often reactive, highlighting opportunities to shift towards more proactive and transparent processes. Conclusions: Overall, RMMRs are a complex system-dependent process. Initiatives addressing identified challenges and strengthening consumer participation, improving interdisciplinary collaboration, integrating digital solutions and targeted policy reforms may enhance RMMR uptake and impact in Australian aged care.