Reducing medication wastage is a paramount objective in promoting appropriate utilisation of finite resources and preventing negative consequences. The aim of this research was to investigate aspects of medication wastage in Malta by applying mixed methods research and, by doing so, contribute original knowledge to this area. A systematic review was conducted to appraise critically, synthesize and present the available evidence on the possible causative factors associated with medication wastage and the effectiveness of any interventions focusing on wastage reduction as an outcome measure. Findings indicated that only one published paper reported a definition of medication wastage. The main factors contributing to wastage were ‘change in medication’, ‘patient's death’, ‘resolution of patient's condition’ and ‘passed expiry date’. Very few studies reported medication wastage as an outcome measure. The Delphi technique was applied to define ‘medication wastage’ and its contributory factors in the context of the Maltese population. A definition for medication wastage was generated with 86% of panellists agreeing/totally agreeing and sixty-one possible factors leading to wastage were identified by the panellists. The perspectives of the Maltese population, healthcare professionals and students on medication wastage were investigated through cross-sectional surveys. Results of questionnaires indicate lack of patient education and knowledge with the free healthcare system and the overstocking of medication by patients due to previous or potential out of stock situations as contributors to medication wastage. The beliefs and behaviours regarding medication wastage of the Maltese public and healthcare professionals were explored during focus groups. The theoretical domains framework was adopted to design the focus group guide and to interpret systematically the findings. Five key themes emerged which were proposed as solutions to minimise medication wastage: system effects, practitioner effects, patients effects, political effects and awareness and educational effects Research results and findings from all four phases will facilitate the systematic development of strategies and policies, with emphasis on prioritisation, with the aim of minimising medication wastage at all levels.

Medication shortages in the Netherlands are the highest they have ever been while approximately 20% of all medication is being thrown away unused. Combined with strengthened ambitions from the Dutch government to improve the sustainability of the healthcare sector, voices have become louder to consider the redispensing of medication. In this study, the perspectives of nurses, pharmacists, and prescribers that are active in the medication chain for Dutch nursing homes have been gathered regarding this strategy to reduce the medication wastage. Semi-structured interviews were organized, transcribed, and subsequently analysed through the framework method. The aim of this study is to enable policy makers to include the perspectives of stakeholders in the medication chain for nursing homes on medication leftovers and on the strategy of redispension in their strengthened ambitions on sustainable healthcare. The results of the analysis showed that medication wastage is a multi-causal problem that is considered as a negative aspect of the current system by all stakeholders. Redispension was seen as a realistic additive to the current practices, under the condition that the quality of the medication could be assured, that the stakeholders are provided with enough information, and that the system would be financially viable. Circular strategies such as rethink, refuse and reduce are possible effective options to reduce the medication leftovers as well. Several recommendations were made for nursing homes from examples in nursing homes that were collected during the study.