This study demonstrated that implementing the NMS in a real-world setting where patients transitioned from hospital to primary care enabled pharmacists to identify DRPs in the majority of patients and provide additional counselling. Furthermore, patients were more satisfied with the information received about their medicine and reported higher self-efficacy and medicine understanding. Those at higher risk of DRPs were recently discharged from the hospital, new to cardiovascular medication, taking other prescriptions, and younger. However, the NMS did not improve first-fill discontinuation.

Previous studies align with the findings of this study, showing that DRP frequency varies by classification, patient population, medication type, and follow-up time [29]. Primary care studies show that many patients, starting new cardiovascular medicines, experience DRPs, including side effects, practical problems, and information needs [5, 9, 19].

At care transitions, adequate patient communication is crucial to ensure continuity of care and reduce DRPs [30]. Patient-provider communication is known to be an important predictor of patient satisfaction [31, 32]. Providing adequate pharmacy counselling and detailed medication information can improve patients’ knowledge, beliefs, adherence [33, 34], and attitudes towards services aimed at improving medication outcomes [19, 34].

Patients only learn how a medicine affects them once they start taking it, possibly leading to new questions and concerns about necessity, side effects, and long-term consequences. These issues influence adherence, but cannot be addressed in standard pharmaceutical care at first dispensing [2]. Integrating the NMS in patients’ healthcare journey before the second dispensing might therefore reduce first-fill discontinuation. This study showed that the NMS, when added to usual care, effectively fills that information gap, improving patients’ self-efficacy and understanding of their medicine, similar to other telephone-based strategies [35]. Although it is a relatively short intervention, possibly limiting a sustained effect, it can serve as a valuable starting point for the pharmacist to track patients’ drug-related problems. Moreover, telephone follow-up is a flexible, cost-effective way to improve patient adherence [36]. However, about a quarter of patients did not receive the NMS due to pharmacist time constraints (15.3%) or assessments (8.6%). Different beliefs about service goals among pharmacists can affect fidelity to NMS [37]. Several efforts were made to facilitate implementation, including engagement with the pharmacists, co-creation and piloting of the protocol, and monthly monitoring meetings to discuss and solve implementation barriers [37, 38]. However, these efforts alone seemed insufficient. Therefore, deploying well-trained pharmacy practitioners or pharmacy technicians to perform the NMS together with pharmacists could be a potential facilitator to overcome time constraints and increase patient counselling [17].

To further increase efficiency, pharmacists should identify patients most likely to benefit from the NMS by considering their risk factors for DRPs. This study found that patients experiencing a DRP were more likely to discontinue medication after the first fill [39]. Consistent with other studies, patients using non-cardiovascular medicines, indicating regimen complexity and comorbidity, were at higher risk for DRPs [12, 13]. Additionally, younger patients and those discharged from the hospital who had not used cardiovascular medicines before were more at risk. The counterintuitive result for younger patients (Table 3), albeit small, might be linked to the substantial number of problems identified in the complexity of medication regimen domain (Table 2). These could present challenges to (younger) patients with a more active lifestyle.

This study’s main strength was its real world setting, providing insights into the practical implementation of the NMS. Potential selection bias due to pharmacists’ professional assessments was minimized by providing a limited-information selection list and monthly reviews of exclusion reasons. Additionally, patients with positive attitudes towards pharmaceutical care may have been more likely to participate in follow-up, potentially overestimating satisfaction and self-efficacy, though this likely affected both groups equally, and a significant effect was still observed.

The study aimed to evaluate the NMS’s real-world impact without standardizing intervention delivery. Pharmacists shared their experiences and barriers during scheduled meetings. Lastly, pharmacy technician contact with the control group might have increased awareness of medication effects, potentially influencing adherence and reducing differences between groups.

This study is the first to implement the NMS in transitional care using a pragmatic living-lab approach [21]. By involving pharmacists in the design and real-life testing of the intervention, the study addressed challenges and enhanced generalizability for real-world practices.

The evaluation aimed to assess the NMS’s effectiveness and feasibility in supporting patients during medication initiation after hospital discharge or outpatient visits, using real-world data to inform clinical practice and policy decisions on pharmacist-led interventions in transitional care.

Earlier studies show the applicability of the NMS to other medicines as well; therefore, the NMS performed in this setting could serve as the basis for an extended follow-up adherence intervention. Additionally, a cost-effectiveness analysis could enhance the evaluation of the intervention [17, 40].