Exploration of Utilizing Electronic Health Databases in Evidence-Based Practice Among Iranian Pharmacists: A Survey by Simulation of Health-seeking Pregnant Women

Exploration of Utilizing Electronic Health Databases in Evidence-Based Practice Among Iranian Pharmacists: A Survey by Simulation of Health-seeking Pregnant Women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploration of Utilizing Electronic Health Databases in Evidence-Based Practice Among Iranian Pharmacists: A Survey by Simulation of Health-seeking Pregnant Women Hooman Pourbala, Ghader Mohammadnezhad, Hadi Esmaily This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6557624/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Apr, 2026 Read the published version in Journal of Pharmaceutical Health Care and Sciences → Version 1 posted You are reading this latest preprint version Abstract Background: Evidence-based medicine (EBM) uses the most reliable evidence available to enhance decision-making in patient care, thereby improving the treatment plan success, patient compliance, rational use of medications, and reducing healthcare costs. Objectives: This study evaluated the knowledge, attitude, and practice of Iranian pharmacists regarding EBM utilization in community pharmacies. Methods: A 36-item questionnaire was designed and validated to assess the knowledge and attitudes of community pharmacists. A simulated-patient method was used to evaluate the practice one week after completing the questionnaire. Results: Within 284 pharmacy visits, the results of 200 pharmacists were collected entirely. Pharmacists aged 24-65 were included in the study. The average knowledge score of pharmacists was 37.91±15.4 out of 100. The pharmacists aged 24-29 demonstrated higher knowledge levels than pharmacists aged 30-65 ( P =0.042). Furthermore, those who dispensed more than 30 prescriptions daily showcased a higher knowledge level ( P =0.024). Additionally, it was found that pharmacists who utilized UpToDate® exhibited greater knowledge and practice in comparison to others who did not use this clinical resource ( P <0.001). Most pharmacists had a positive attitude towards EBM and its implementation in the pharmacy (99.5%). The mean score of practice in managing the simulated-patient was 50.34 ± 21.35. A direct association was detected between knowledge and practice (r=0.73, P <0.05). There was no association between pharmacists' attitudes and their practice scores. Conclusion: Most pharmacists agreed about the crucial need to incorporate EBM into pharmacy practices. Pharmacists with advanced knowledge of EBM and using UpToDate® showed better knowledge and practice. Evidence-Based Medicine Public Health Pharmacy Practice Health Services Research Figures Figure 1 Figure 2 Introduction Pharmacists play a pivotal role in enhancing public health outcomes, including the management of chronic diseases and health promotion. In community pharmacies, they uphold ethical and professional obligations by advising patients on medication usage and managing common minor ailments, such as headaches, colds, and allergies, through the provision of over-the-counter (OTC) treatments (1–3). To effectively fulfill these responsibilities, pharmacists must be well-versed in the principles of evidence-based medicine (EBM), which is defined as the systematic and judicious use of the most current and reliable evidence to inform clinical decisions regarding individual patient care (2,4,5). Prominent organizations, including the World Health Organization (WHO), the American Association of Colleges of Pharmacy (AACP), and the International Pharmaceutical Federation (FIP), have emphasized the necessity of integrating EBM into pharmacy practice to ensure good pharmacy practice (GPP) (6–8). By employing EBM, pharmacists can significantly enhance the effectiveness of treatment plans, thereby improving patient outcomes and minimizing unnecessary interventions (9,10). This approach not only fosters patient adherence to prescribed therapies but also promotes the optimal use of medications and the efficient allocation of clinical resources within the community. Ultimately, the adoption of EBM is associated with improved quality of life for patients and a reduction in the socioeconomic burden of diseases (11–13). One effective strategy for evaluating the application of EBM in practice is the simulated patient method (SPM). This method serves as a valuable tool to accurately assess healthcare professionals' practices. A simulated patient (SP) is trained to authentically represent a patient, consistently presenting a specific chief complaint (14–16). However, the SPM has not been widely adopted in pharmacy practice in Iran. By employing the SPM, researchers can assess real-life scenarios rather than relying solely on self-reported performance, thus identifying strengths and weaknesses in pharmacists' interactions with patients (17,18). This method provides diverse scenarios that evaluate a broader range of pharmacists' skills and knowledge, yielding insights into the professionalism and clinical competence of healthcare providers. Consequently, these insights can inform the development of targeted strategies to address identified performance deficiencies. Designing an effective SP scenario poses several challenges, as it requires considerable time and effort to understand the specific needs of the target population. It is essential to maintain flexibility in the framework to adapt to unforeseen changes (16,19,20). Various e-health platforms, including Cochrane®, Medscape®, Micromedex®, and UpToDate® are available for seeking health information. However, previous studies have indicated that these tools are not widely integrated into the daily practices of healthcare professionals, leaving them reliant on traditional methods for information retrieval (21,22). This research aimed to assess the knowledge, attitudes, and practices (KAP) of Iranian pharmacists regarding the utilization of electronic information databases regarding the implementation of EBM in community. Methods · Study Design & Setting A cross-sectional survey using a mixed-methods approach was conducted from December 2021 to December 2022 in Tehran, Iran, which comprised two components: a researcher-designed questionnaire to assess the knowledge and attitude of participants, and an SPM for evaluating their practices. The manuscript followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for standardization (23). · Ethical Consideration The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the study protocol with the registered code IR.SBMU.PHARMACY.REC.1399.212. The study objectives and procedures were explained to the pharmacists to help their full comprehension. Furthermore, a written informed consent was obtained from the pharmacists to convey the purpose, potential risks, and benefits of the study. The main reason for acquiring verbal informed consent was to conceal the SP during regular visits of the patients. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the procedure for obtaining verbal informed consent. · Participants Community pharmacists (CPs) of Tehran were invited to participate in this survey. The study utilized Health Information Exchange (HIX), an online national pharmacy management system in Iran (http://pharmacy.fda.gov.ir), which maintains records of all pharmacies, including their addresses, details about the pharmacists employed, and contact numbers. At the time of the study, a query from this system indicated that there were approximately 2,500 pharmacies operating in Tehran and the sample size was calculated based on this information. During an initial meeting with the CPs, the research team outlined the study's objectives, emphasized ethical considerations, and highlighted the importance of maintaining participant confidentiality. Regarding the eligibility criteria, participants were included if they provided written informed consent to complete the questionnaire and engage with the SP. Pharmacists who did not complete the questionnaire were excluded from the study. · Data Sources & Variables We collected demographic information from the participants during the initial meeting. This information included their age, gender, highest level of education, work experience, average hours worked per day in the pharmacy, years since graduation, the usual number of daily prescriptions checked, and regular use of scientific resources and references. Furthermore, the measured variables by the questionnaire were knowledge and attitude of CPs toward EBM. In addition, we informed participants that the data collection process would be finalized within a week, utilizing an SPM for practice measurement. · Outcome Measurements To achieve the study outcomes, we implemented the following methodologies: 1. Development of the Knowledge & Attitude Questionnaire Initially, an expert panel comprised ten specialists from various fields, including clinical pharmacy, pharmacy practice, family medicine, nutritional science, pharmacology, and toxicology. The expert panel referred to the university faculty members who collaborated to consult and design the case scenario. A questionnaire was designed based on six essential domains identified by the panel to assess the knowledge and attitude of healthcare professionals towards EBM. These domains were the knowledge of EBM principles, familiarity with EBM resources, attitude toward EBM, application of EBM in practice, barriers to EBM implementation, continuing education and training needs. The questionnaire was developed following a thorough review of literature and underwent three rounds of editing. After revising the questionnaire, the content validity of it was evaluated regarding simplicity, clarity, relevance, and necessity. Content validity index (CVI) and content validity ratio (CVR) were calculated based on expert opinions. A CVI greater than 0.8 was deemed acceptable according to Waltz and Baussel's criteria (24). To assess the internal consistency of the questionnaire using Cronbach's alpha coefficient, we provided it to 50 pharmacists during the Iranian Clinical Pharmacy Congress. Upon the collection of the responses, an alpha value of 0.7-0.9 was considered as an acceptable range of internal consistency. The results of these 50 volunteers were not included in the final analysis. The questionnaire was translated following standard guidelines for translation, which involve preparation, forward translation/matching, back translation done by an authorized translator, harmonization, and validation to publish it in English. Final version of the knowledge and attitude questionnaire is available in the supplementary file 1. 2. Assessing the Pharmacy Practice by a Simulated Patient The SP scenario was developed according to the Standards of Best Practice for Simulation (SOBP) (20). The SOBP consists of five main domains: 1) Safe work environment: Three crucial principles were taken into account to foster respect, ensure adherence to safe work practices, and maintain confidentiality. 2) Case Development: Two fundamental principles guide the development of SP case materials: thorough preparation and consideration of case components. Expertise in creating teaching and assessment materials is crucial for SP educators, considering the critical role that case-related materials play in their work. 3) Training SPs: Comprehensive training is essential for SPs as it equips them with the necessary skills to accurately and consistently portray roles, provide effective feedback, and proficiently utilize assessment tools. SP educators have to integrate and align the development of these individual skills with the SP's unique experience and the educational objectives of the practice. 4) Program management: SP programs should be cost-effective and adhere to purpose, expertise, policies, procedures, precise records control, teamwork, and quality. 5) Professional development: SP educators actively engage in professional development to foster sufficient expertise in clinical practices. To evaluate the feasibility of the SPM and identify any weaknesses, a preliminary pilot study was conducted with 50 pharmacists in Tehran. The results of these 50 pharmacists were not included in the final analysis. The approach of SP in pharmacy practice evaluation is detailed in the supplementary file. Each response from the pharmacist and the steps they take during the history-taking process with the SP served as key criteria for assessing the professional and clinical competence of the participants. To prevent the SP from misleading the study participants, the names and profiles of the pharmacists were received in the questionnaire. Subsequently, the pharmacists' pictures were obtained from the Iran's medical system database (https://membersearch.irimc.org/) and provided them to the SP. This allowed the SP to refer to the desired pharmacist according to the picture. If the pharmacist was not present in the pharmacy, that pharmacy would be visited again. Case Scenario: A female pharmacy student was chosen and given specialized training to act as an SP whose physical attributes closely resembled a pregnant woman's. We provided education to our student regarding a 25-35 years old woman with a medical history of systemic lupus erythematosus. She was uncertain about taking a particular prescription medication during her ninth week of pregnancy. Figure 1. represents an overview and examples of potential responses a pharmacist might give to the SP. · Scoring Systems When assessing the quality of medication counseling, it is crucial to consider two key factors: logical questioning and providing accurate advice. An inductive approach was used to develop a comprehensive set of scoring criteria for evaluating the quality of medication counseling. This approach focused on two main categories: assessing the patient's needs and providing clear instructions for medication use (25). The expert panel designed the scoring system for this project. A general core was assumed for classifying the pharmacist's questions, recommendations, and approach to the case. As a result, a scoring system was created for the fulfillment or non-fulfillment of each of the assumed items, which is provided in the supplementary file 2. Moreover, the SP scored the practice of the pharmacists immediately after leaving each visited pharmacy, evaluating them on a case-by-case basis. · Bias We only invited individuals who fully met the eligibility criteria to address the selection bias. As knowledge and attitude have been assessed using scientific questions, we tend to reduce the risk of social desirability bias, which could occur if pharmacists altered their responses based on perceived expectations. In addition, the pharmacists were not informed of details regarding the SP’s identity, medical condition, or the specific timing of the visit. This lack of information was crucial in helping an unbiased assessment of their actual practice. Considering that pharmacies in Tehran serve an average of around 250 clients per day, and since the SP visit happened several days after the initial visit, the potential for recall bias was deemed minimal. To further address potential biases associated with the SP, she was rigorously trained to adhere strictly to a standardized script during visits, ensuring consistency in the interactions with pharmacists. By following this protocol, we aimed to closely replicate typical practice conditions, thereby reducing the likelihood of behavior modification resulting from the awareness of being observed. Furthermore, the scenario provided by the SP was not directly connected to the knowledge and attitude questionnaire, which diminished the possibility of bias. · Sampling A cluster-stratified sampling was implemented to recruit community pharmacies from various regions of Tehran, specifically the northern, southern, eastern, western, and central areas. Within each region, a convenience sample of community pharmacies was utilized. The sample size was calculated using Cochran's statistical formula, tailored to the study population. Our objective was to achieve a precision level of 7% within a 95% confidence interval, based on a target population of about 2,500 pharmacies. Considering that each pharmacy is associated with a single pharmacist in Iran, we determined that a minimum sample size of 182 pharmacists was necessary to meet this precision requirement. · Data Analysis Data analysis was conducted using SPSS version 26 software. Descriptive statistics were reported as frequencies and means ± standard deviation (SD). The Kolmogorov-Smirnov test was employed to assess the normality of the data distribution. To compare the sub-groups that existed in the characteristics of the participants, both the t-test and analysis of variance (ANOVA) were utilized. The Chi-Square test was applied to examine relationships between non-parametric variables. Additionally, Tukey's Honestly Significant Difference (HSD) post-hoc test was conducted for multiple comparisons following ANOVA. The relationship between the average knowledge and performance scores of participants and the sub-groups of their characteristics was also assessed using the Chi-Square test. A significance threshold of P <0.05 was set to determine statistical significance. Results The prototype questionnaire achieved a CVI of 0.82 and a Cronbach's alpha of 0.81 for 50 pharmacists. Within 284 pharmacy visits, 200 pharmacists completed the study per protocol. After a week, their practice was evaluated with the SP. Of the 84 participants excluded from the analysis, 48 decided not to participate, 17 did not finish the questionnaires, and 19 pharmacists were not available during the SP's visit. Figure 2 . shows the flow diagram of participants in more detail. Out of 200 included pharmacists, 68 were men, and 132 were women. Regarding the highest level of education, 92.5% had a PharmD, 6% had a PhD, and 1.5% had a B.Pharm. Detailed demographic data of the study participants can be found in Table 1 . Table 1 Demographic characteristics of pharmacists (N = 200). Variables Subgroups N (%) Age 20–29 60 ( 30 ) 30–39 67 (33.5) 40–49 38 ( 19 ) 50–65 35 (17.5) Gender Male 68 ( 34 ) Female 132 (66) Highest level of education Pharm.D. 185 (92.5) Ph.D. 12 ( 6 ) B.Pharm. 3 (1.5) Work experience Less than 5 years 79 (39.5) 5–10 years 52 ( 26 ) More than 10 years 69 (34.5) Years since graduation 1–10 years 94 (47) 11–20 years 54 ( 27 ) 21–30 years 29 (14.5) More than 30 years 23 (11.5) Use of scientific resources and references Online resources 161 (80.5) Electronic information databases (UpToDate®) 95 (47.5) Table 2 . shows the results of the pharmacists' attitudes about the impact of utilizing electronic information databases. Many pharmacists (58%) believed that the references available in community pharmacies were inadequate for answering the patients' questions (Q1). Most pharmacists (95.5%) do not believe that having a lot of work experience and personal knowledge improves the quality of pharmacy practice (Q2). Most pharmacists (86.5%) believed that it becomes impractical to use medical resources to help clients when pharmacies are overcrowded (Q3). In addition, a majority of 65.5% believed that searching for information in scientific resources in the presence of the patient can cause cynicism among patients, while 22% had the opposite opinion (Q4). Likewise, 62.5% of pharmacists disagreed that a pharmacist's work experience is more efficient than searching with scientific resources. Conversely, 18.5% of pharmacists agreed with this statement (Q5). Pharmacists indicated it is important to consult reliable scientific resources to ensure the safe use of drugs during pregnancy and breastfeeding. They also agreed on the importance of pharmacists checking prescription drug interactions in community pharmacies (Q6, Q7). Most participants (71.5%) disagreed with the idea that guidance, counseling, and the use of credible scientific resources in pharmacies cause confusion and anxiety in patients (Q8). Most pharmacists (78.5%) believed that using scientific resources and EBM improves patients' satisfaction and adherence to pharmacotherapy (Q9). Table 2 The attitudes of pharmacists towards health services and EBM in community pharmacies. 1. Pharmacists' attitudes towards using references to answer patients' questions. Agree 83 (41.5%) Disagree 116 (58%) Neutral 1 (0.5%) 2. Pharmacists' attitudes towards their knowledge and years of experience. Agree 6 (3%) Disagree 191 (95.5%) Neutral 3 (1.5%) 3. Pharmacists' attitudes towards the impossibility of searching for answer patients' questions during the busy time of the pharmacy. Agree 173 (86.5%) Disagree 23 (11.5%) Neutral 4 (2%) 4. Pharmacists' attitudes towards patients' negative mentality towards pharmacist knowledge when referring to scientific resources. Agree 131 (65.5%) Disagree 44 (22%) Neutral 25 (12.5%) 5. Pharmacists' attitudes towards the effectiveness of work experience instead of referring to scientific resources. Agree 37 (18.5%) Disagree 125 (62.5%) Neutral 38 (19%) 6. Pharmacists' attitudes towards the need to use scientific resources to check the risks of medicines during pregnancy and breastfeeding for all patients. Agree 199 (99.5%) Disagree 0 Neutral 1 (0.5%) 7. Pharmacists' attitudes regarding the non-necessity of checking drug interactions by a pharmacist versus the examination of drug interactions by a physician. Agree 0 Disagree 200 (100%) Neutral 0 8. Pharmacists' attitudes regarding anxiety and confusion in managing patients will change and reduce the acceptance of medications if the information is provided completely. Agree 21 (10.5%) Disagree 143 (71.5%) Neutral 36 (18%) 9. Pharmacists' attitudes towards increasing patient satisfaction by using reliable resources to respond to patients. Agree 157 (78.5%) Disagree 8 (4%) Neutral 35 (17.5%) The results in Table 3 . indicate that many pharmacists did not utilize a suitable scientific resource and underperformed in obtaining the patient's medical history and making a proper clinical decision. Altogether, their practice was poor to moderate. The study found that pharmacists' practice scores ranged from 13 to 90 out of 100, averaging 50.34 ± 21.35. Table 3 Pharmacists' practice towards EBM implementation and taking past medical history. 1. Pharmacist statement about clinical management after taking a complete history. Yes 131 (65.5%) No 69 (34.5%) 2. Ask the SP's age. Yes 24 (12%) No 176 (88%) 3. Ask for past medical history. Yes 113 (56.5%) No 87 (43.5%) 4. Writing notes while taking history. Yes 32 (16%) No 168 (84%) 5. Ask for family health history. Yes 41 (20.5%) No 159 (79.5%) 6. Ask about taking medications. Yes 140 (70%) No 60 (30%) 7. Ask about a history of drug or food allergies. Yes 9 (4.5%) No 191 (95.5%) 8. Quick selection and correct use of scientific and information resources. Yes 59 (29.5%) No 141 (70.5%) 9. Provide the proper clinical decision. Yes 60 (30%) No 140 (70%) 10. Professional discipline in managing the SP. (Score) 4 36 (18%) 3.5 34 (17%) 3 23 (11.5%) 2.5 24 (12%) 2 27 (13.5%) 1.5 38 (19%) 1 13 (6.5%) 0.5 5 (2.5%) 11. Provide needed education in plain and understandable language for the SP. (Score) 3 1 (0.5%) 2.5 16 (8%) 2 76 (38%) 1.5 92 (46%) 1 14 (7%) 0.5 2 (1%) 12. Explain follow-up tips to the SP after clinical decision. Yes 42 (21%) No 158 (79%) 13. Receive educational feedback from the SP. Yes 9 (4.5%) No 191 (95.5%) 14. Overall practice assessment. Very Poor 57 (28.5%) Poor 77 (38.5%) Good 65 (32.5%) Very Good 1 (0.5%) SP: Simulated patient The assessment of pharmacists' knowledge reveals that their overall score in EBM is 37.91 ± 15.4, signifying a range of weak to moderate proficiency. Table 4 . shows the relationship between knowledge scores and other study parameters. Table 4 Relationships between knowledge and practice scores with other variables. Characteristics Subgroups Knowledge Score P Practice Score P Age 24–29 44.22 ± 16.11 0.042* 48.2 ± 16.4 0.047* 30–39 39.80 ± 12.85 53.0 ± 23.2 40–49 40.00 ± 14.43 49.5 ± 20.7 50–65 37.20 ± 19.11 48.1 ± 21.0 Gender Male 37.44 ± 14.28 0.688 50.4 ± 21.0 0.997 Female 38.39 ± 16.52 50.3 ± 21.7 Highest level of education Pharm. D. 38.17 ± 15.72 0.966 50.3 ± 22.0 0.886 Ph.D. 37.00 ± 17.97 51.7 ± 22.8 B. Pharm. 36.00 ± 30.40 45.0 ± 32.1 Work experience (years) 10 40.15 ± 18.31 55.4 ± 21.8 Number of daily prescriptions dispensed 30 46.51 ± 20.64 56.8 ± 21.5 Use of scientific resources and references Online resources 35.51 ± 15.33 0.032* 46.2 ± 21.5 0.018* Electronic information databases (UpToDate®) 39.86 ± 17.00 52.8 ± 22.2 Both 45.00 ± 17.86 59.3 ± 21.9 Analysis of the study population revealed that younger and less experienced pharmacists, as well as those who used electronic clinical resources such as UpToDate®, showed better practice regarding SP. The results revealed that most pharmacists have a limited to moderate understanding of EBM. Subsequently, their clinical practice reflects this insufficient knowledge. There was a positive correlation between the number of prescriptions dispensed daily and the enhancement of pharmacists' knowledge. However, it did not significantly affect their practice. Subgroup analysis is also shown in detail in Table 4 . Discussion This study represents the first examination of the relationship between e-health literacy and KAP among Iranian CPs. We employed a mixed-methods approach that incorporated two components: a questionnaire designed by an expert panel to assess pharmacists' knowledge and attitudes, alongside an SPM to evaluate their practices. The novelty of our research is underscored by the critical influence that patient consultations with pharmacists can have on both maternal and fetal health, emphasizing the need for pharmacists to verify updated resources to support EBM. Our findings indicate that Iranian pharmacists generally lack sufficient knowledge about available resources, which hinders their ability to search for and study valid and current publications. Furthermore, most pharmacists reported insufficient time as a key obstacle to utilize these resources properly within community pharmacy settings. Although the study found a generally positive attitude towards EBM among Iranian pharmacists, it is evident that many do not utilize electronic information databases and possess limited knowledge regarding them. A positive correlation was found between advanced levels of knowledge and enhanced practice among CPs. In addition, we discovered that those participants who utilized UpToDate® and online resources exhibited significantly improved knowledge and practices. These findings suggest that using reliable online resources may play a crucial role in the professional development of a pharmacist. Additionally, our results demonstrated a concerning trend: pharmacists' knowledge and familiarity with resources for addressing patients' medication needs tend to decline or remain static as they age. It can be inferred that older pharmacists often face multiple challenges such as inadequate facilities and limited opportunities for ongoing training, which may lead to a gradual decline of their knowledge and skills. However, younger pharmacists not only benefit from advanced scientific knowledge, but also demonstrated greater familiarity with reputable databases and references. In this study, most Iranian pharmacists held a PharmD degree, while others had a bachelor's degree or a PhD. However, no statistically significant difference was observed in knowledge levels across these educational attainment groups. Also, while the majority of surveyed pharmacists had less than five years of work experience, no correlation was identified between knowledge levels and work experience among pharmacists with < 30 years in the profession compared to other groups. Moreover, younger and less experienced pharmacists demonstrated higher knowledge and proficiency in clinical management. Several studies have explored the impact of age and experience on EBM among healthcare professionals ( 17 , 26 ). A study conducted on 55 CPs in Jordan utilizing SPM, revealed that older pharmacists with extensive years of experience were more likely to provide necessary information proactively, without awaiting patient inquiries. In contrast, pharmacists with less than five years of experience and higher confidence levels were more inclined to respond when patients specifically sought information. Furthermore, research indicates that as more time elapses since graduation, the knowledge and skills of healthcare professionals may diminish ( 21 , 26 – 28 ). This gap emphasizes the critical need for ongoing education in performing EBM and maintaining clinical expertise. It is worth mentioning that in a systematic review of 57 articles on physicians' KAP toward EBM, consulting with colleagues was recognized as the primary source of information for EBM. Interestingly, e-health services were reported as the least favored resource among physicians in this study ( 29 ). In contrast, a study in the United States involving clinical assistants found that over 70% of participants preferred using online resources, indicating a potential shift towards the adoption of e-health platforms in clinical settings ( 30 ). Previous studies have identified the primary resources that pharmacists usually rely on for finding clinical evidence, including international guidelines, textbooks, Wikipedia, Google Scholar, PubMed/Medline, Medscape®, The Database of Abstracts of Reviews of Effectiveness (Dare®), Cochrane®, EvidenceUpdates®, the Turning Research into Practice (Trip®), LexiComp®, Micromedex®, and UpToDate® ( 21 , 22 , 31 ). The reliance on a diverse range of sources highlights the necessity for comprehensive training in the utilization of these tools. Furthermore, it implies that the accessibility to and familiarity with these resources may vary among pharmacists ( 28 , 32 , 33 ). Recent research has recognized several barriers to the integration of EBM in routine practice. These barriers include time constraints, insufficient knowledge and skills, patient overload, chaotic work environments, lack of financial resources, inadequate facilities to ensure patient privacy, absence of an integrated communication framework within the healthcare system, incomplete access to patient records, insufficient societal awareness regarding the critical role of healthcare professionals, a focus on increasing product sales, inadequate motivation for time-consuming consultations, and restricted access to e-health platforms for pharmacists. Additionally, few articles have highlighted that a primary obstacle to utilizing scientific resources in daily practice is the lack of sufficient authority to modify patient care protocols and resistance to change ( 2 , 14 , 31 , 34 , 35 ). This study encountered several obstacles in the collection and reporting of relevant information that could potentially impact the results. The major challenges were the absence of pharmacists in certain pharmacies during the visits, an uneven distribution of community pharmacies across Tehran, patient overload, and difficulties in scheduling meetings with pharmacists. Another limitation of our study was the potential subjectivity in scoring by the SP. Furthermore, it is noteworthy that 63.5% of the participants were > 40 years old, and our sample size was limited. Consequently, it can be inferred that in a larger population, the actual level of knowledge and performance may be lower than what was reported in this study. Moreover, an important consideration is that since participants were required to be clearly informed of the study's objectives, the SP's visits were scheduled over a one-week period following their responses to the questionnaires. This timing raises the possibility that pharmacists may have performed better solely during this specific timeframe, potentially influencing our results. To mitigate this bias, future studies should consider implementing a longer observation period, randomizing the scheduling of visits, and employing different SPs simultaneously to better assess the pharmacists' knowledge and performance across varying conditions. In addition, incorporating a diverse range of assessment methods could provide a more comprehensive evaluation of pharmacists' competencies and help identify specific areas for improvement. Given the current challenges within Iran's pharmaceutical system, many pharmacists may not follow EBM in their daily practice or may not be sufficiently familiar with the tools that support this approach. Our study showed that using electronic information databases like UpToDate® improved pharmacists' knowledge scores and helped them make more evidence-based decisions. This finding implies that utilizing these valuable resources can bridge the gap between the attitude and actual implementation of EBM in community pharmacies. In this case, the results of our study could alert health policymakers to consider clearer frameworks to enhance the knowledge and performance levels in critical aspects of the health, such as medication consumption during pregnancy, and to address existing barriers to ultimately improve patient quality of life. Further studies are warranted to explore the KAP of Iranian CPs regarding the impact of scientific resources and e-health tools in clinical appraisal by using more standardized questionnaires and more rigorous methodologies. Conclusion In conclusion, our study has revealed that although pharmacists have a positive attitude towards incorporating EBM into their professional practice, there is still a substantial potential and scope for improvement in their knowledge and practice. Meanwhile, those pharmacists who utilized UpToDate® demonstrated superior knowledge and practice. Moreover, a positive correlation was observed between higher levels of knowledge and improved practice among pharmacists. Declarations Ethics approval and consent to participate All methods were completed under the principles of the Declaration of Helsinki. The Ethics Committees of Shahid Beheshti University of Medical Sciences approved the study protocol during a regular session (IR.SBMU.PHARMACY.REC.1399.212.). A verbal informed consent was obtained from the participants. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the procedure for obtaining verbal informed consent. Consent for publication Not applicable. Availability of data and materials All data analyzed during this study is provided within the manuscript. Competing interests None. Funding Not funded. Authors' contributions HE designed the SP and study plan, HP searched the databases and extracted the desired data, GM categorized the data, HE conducted the statistical analysis and extracted the interpreted the results, and HP and GM drafted the manuscript. All authors reviewed the manuscript. Acknowledgements We want to thank the Student Research Committee of Shahid Beheshti University of Medical Sciences for its support in providing the ethical code. References Sato N, Fujita K, Kushida K, Chen TF. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6557624","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486036330,"identity":"90b37e6e-e370-4cb2-a2c6-3cf988844f05","order_by":0,"name":"Hooman Pourbala","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hooman","middleName":"","lastName":"Pourbala","suffix":""},{"id":486036331,"identity":"dcb9ea93-9872-4c01-8ced-1bd605e735d6","order_by":1,"name":"Ghader Mohammadnezhad","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ghader","middleName":"","lastName":"Mohammadnezhad","suffix":""},{"id":486036332,"identity":"6712840b-9ba4-43aa-b101-6da160479185","order_by":2,"name":"Hadi Esmaily","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBAC+wYgkVDAwGAARAc+MByAihvg1gKWSjCAaDk4g2gtDFAtzDxwLXiAAf/pxA8PDA4zmLMf3njY5s+daIMDzA8/MBTcw+0XidzNEglALZY9aQWHc9ue5W44wGYswWBQjNsWCd4NYC0GB3IMDuc2HAZqYTADiifgcdjZzT/AWs6/MThs8Qekhf0bfi0MudsgttwA2sLABtLCQ8AWidxtFgkG6UAtzwoO9gL9MvMwTzHQENxa7PvPbr75o8Ia6LDkzR9+/LmT23e8feOHD39wa4GC5voGOJsZiAlqYGCoI6xkFIyCUTAKRi4AAJb7XNBiAFlXAAAAAElFTkSuQmCC","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Hadi","middleName":"","lastName":"Esmaily","suffix":""}],"badges":[],"createdAt":"2025-04-29 14:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6557624/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6557624/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40780-026-00561-7","type":"published","date":"2026-04-02T15:58:40+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87270026,"identity":"d00e7b4a-f76e-4a70-bbcf-7ec5296f4c0c","added_by":"auto","created_at":"2025-07-22 08:17:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":339560,"visible":true,"origin":"","legend":"\u003cp\u003eA hypothetical case scenario scheme.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6557624/v1/5be2497bde932029e9f1ee96.png"},{"id":87272134,"identity":"9cb98733-ffe6-42ab-af44-7f140b18bf42","added_by":"auto","created_at":"2025-07-22 08:25:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":108443,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant flow-diagram.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6557624/v1/c3f99876bd3c0ef53160446b.png"},{"id":106343388,"identity":"4ab42ecd-cf10-4f01-9701-e327582a3c50","added_by":"auto","created_at":"2026-04-07 16:04:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1430006,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6557624/v1/dcfc7c13-97e0-4993-bbdc-05e347757009.pdf"},{"id":87270022,"identity":"9fd07076-7e4b-4756-af69-bfc2c4be9099","added_by":"auto","created_at":"2025-07-22 08:17:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":42141,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6557624/v1/6b33f14583a70b0e5928904c.docx"},{"id":87270024,"identity":"29279df6-c269-4564-ad45-056ab288695d","added_by":"auto","created_at":"2025-07-22 08:17:42","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":24432,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6557624/v1/e53dd579c3e8535e22317f59.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploration of Utilizing Electronic Health Databases in Evidence-Based Practice Among Iranian Pharmacists: A Survey by Simulation of Health-seeking Pregnant Women","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePharmacists play a pivotal role in enhancing public health outcomes, including the management of chronic diseases and health promotion. In community pharmacies, they uphold ethical and professional obligations by advising patients on medication usage and managing common minor ailments, such as headaches, colds, and allergies, through the provision of over-the-counter (OTC) treatments (1\u0026ndash;3). To effectively fulfill these responsibilities, pharmacists must be well-versed in the principles of evidence-based medicine (EBM), which is defined as the systematic and judicious use of the most current and reliable evidence to inform clinical decisions regarding individual patient care (2,4,5).\u003c/p\u003e\n\u003cp\u003eProminent organizations, including the World Health Organization (WHO), the American Association of Colleges of Pharmacy (AACP), and the International Pharmaceutical Federation (FIP), have emphasized the necessity of integrating EBM into pharmacy practice to ensure good pharmacy practice (GPP) (6\u0026ndash;8). By employing EBM, pharmacists can significantly enhance the effectiveness of treatment plans, thereby improving patient outcomes and minimizing unnecessary interventions (9,10). This approach not only fosters patient adherence to prescribed therapies but also promotes the optimal use of medications and the efficient allocation of clinical resources within the community. Ultimately, the adoption of EBM is associated with improved quality of life for patients and a reduction in the socioeconomic burden of diseases (11\u0026ndash;13).\u003c/p\u003e\n\u003cp\u003eOne effective strategy for evaluating the application of EBM in practice is the simulated patient method (SPM). This method serves as a valuable tool to accurately assess healthcare professionals\u0026apos; practices. A simulated patient (SP) is trained to authentically represent a patient, consistently presenting a specific chief complaint (14\u0026ndash;16). However, the SPM has not been widely adopted in pharmacy practice in Iran. By employing the SPM, researchers can assess real-life scenarios rather than relying solely on self-reported performance, thus identifying strengths and weaknesses in pharmacists\u0026apos; interactions with patients (17,18). This method provides diverse scenarios that evaluate a broader range of pharmacists\u0026apos; skills and knowledge, yielding insights into the professionalism and clinical competence of healthcare providers. Consequently, these insights can inform the development of targeted strategies to address identified performance deficiencies. Designing an effective SP scenario poses several challenges, as it requires considerable time and effort to understand the specific needs of the target population. It is essential to maintain flexibility in the framework to adapt to unforeseen changes (16,19,20).\u003c/p\u003e\n\u003cp\u003eVarious e-health platforms, including Cochrane\u0026reg;, Medscape\u0026reg;, Micromedex\u0026reg;, and UpToDate\u0026reg; are available for seeking health information. However, previous studies have indicated that these tools are not widely integrated into the daily practices of healthcare professionals, leaving them reliant on traditional methods for information retrieval (21,22). This research aimed to assess the knowledge, attitudes, and practices (KAP) of Iranian pharmacists regarding the utilization of electronic information databases regarding the implementation of EBM in community.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u0026middot; \u003cstrong\u003eStudy Design \u0026amp; Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional survey using a mixed-methods approach was conducted from December 2021 to December 2022 in Tehran, Iran, which comprised two components: a researcher-designed questionnaire to assess the knowledge and attitude of participants, and an SPM for evaluating their practices. The manuscript followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for standardization\u0026nbsp;(23).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Shahid Beheshti University of Medical Sciences approved the study protocol with the registered code IR.SBMU.PHARMACY.REC.1399.212. The study objectives and procedures were explained to the pharmacists to help their full comprehension. Furthermore, a written informed consent was obtained from the pharmacists to convey the purpose, potential risks, and benefits of the study. The main reason for acquiring verbal informed consent was to conceal the SP during regular visits of the patients. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the procedure for obtaining verbal informed consent.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCommunity pharmacists (CPs) of Tehran were invited to participate in this survey. The study utilized Health Information Exchange (HIX), an online national pharmacy management system in Iran (http://pharmacy.fda.gov.ir), which maintains records of all pharmacies, including their addresses, details about the pharmacists employed, and contact numbers. At the time of the study, a query from this system indicated that there were approximately 2,500 pharmacies operating in Tehran and the sample size was calculated based on this information. \u003cstrong\u003eDuring an initial meeting with the CPs, the research team outlined the study\u0026apos;s objectives, emphasized ethical considerations, and highlighted the importance of maintaining participant confidentiality.\u0026nbsp;\u003c/strong\u003eRegarding the eligibility criteria, participants were included if they provided written informed consent to complete the questionnaire and engage with the SP. Pharmacists who did not complete the questionnaire were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eData Sources \u0026amp; Variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe collected demographic information from the participants during the initial meeting. This information included their age, gender, highest level of education, work experience, average hours worked per day in the pharmacy, years since graduation, the usual number of daily prescriptions checked, and regular use of scientific resources and references. Furthermore, the measured variables by the questionnaire were knowledge and attitude of CPs toward EBM. In addition, we informed participants that the data collection process would be finalized within a week, utilizing an SPM for practice measurement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026middot;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eOutcome Measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTo achieve the study outcomes, we implemented the following methodologies:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1. \u003cstrong\u003eDevelopment of the Knowledge \u0026amp; Attitude Questionnaire\u003c/strong\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitially, an expert panel comprised ten specialists from various fields, including clinical pharmacy, pharmacy practice, family medicine, nutritional science, pharmacology, and toxicology. The expert panel referred to the university faculty members who collaborated to consult and design the case scenario. A questionnaire was designed based on six essential domains identified by the panel to assess the knowledge and attitude of healthcare professionals towards EBM. These domains were the knowledge of EBM principles, familiarity with EBM resources, attitude toward EBM, application of EBM in practice, barriers to EBM implementation, continuing education and training needs.\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed following a thorough review of literature and underwent three rounds of editing. After revising the questionnaire, the content validity of it was evaluated regarding simplicity, clarity, relevance, and necessity. Content validity index (CVI) and content validity ratio (CVR) were calculated based on expert opinions. A CVI greater than 0.8 was deemed acceptable according to Waltz and Baussel\u0026apos;s criteria\u0026nbsp;(24).\u003c/p\u003e\n\u003cp\u003eTo assess the internal consistency of the questionnaire using Cronbach\u0026apos;s alpha coefficient, we provided it to 50 pharmacists during the Iranian Clinical Pharmacy Congress. Upon the collection of the responses, an alpha value of 0.7-0.9 was considered as an acceptable range of internal consistency. The results of these 50 volunteers were not included in the final analysis. The questionnaire was translated following standard guidelines for translation, which involve preparation, forward translation/matching, back translation done by an authorized translator, harmonization, and validation to publish it in English. Final version of the knowledge and attitude questionnaire is available in the supplementary file 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2. \u003cstrong\u003eAssessing the Pharmacy Practice by a Simulated Patient\u003c/strong\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SP scenario was developed according to the Standards of Best Practice for Simulation (SOBP)\u0026nbsp;(20). The SOBP consists of five main domains: 1) Safe work environment: Three crucial principles were taken into account to foster respect, ensure adherence to safe work practices, and maintain confidentiality. 2) Case Development: Two fundamental principles guide the development of SP case materials: thorough preparation and consideration of case components. Expertise in creating teaching and assessment materials is crucial for SP educators, considering the critical role that case-related materials play in their work. 3) Training SPs: Comprehensive training is essential for SPs as it equips them with the necessary skills to accurately and consistently portray roles, provide effective feedback, and proficiently utilize assessment tools. SP educators have to integrate and align the development of these individual skills with the SP\u0026apos;s unique experience and the educational objectives of the\u0026nbsp;practice. 4) Program management: SP programs should be cost-effective and adhere to purpose, expertise, policies, procedures, precise records control, teamwork, and quality. 5) Professional development: SP educators actively engage in professional development to foster sufficient expertise in clinical practices.\u003c/p\u003e\n\u003cp\u003eTo evaluate the feasibility of the SPM and identify any weaknesses, a preliminary pilot study was conducted with 50 pharmacists in Tehran. The results of these 50 pharmacists were not included in the final analysis. The approach of SP in pharmacy practice evaluation is detailed in the supplementary file. Each response from the pharmacist and the steps they take during the history-taking process with the SP served as key criteria for assessing the professional and clinical competence of the participants.\u003c/p\u003e\n\u003cp\u003eTo prevent the SP from misleading the study participants, the names and profiles of the pharmacists were received in the questionnaire. Subsequently, the pharmacists\u0026apos; pictures were obtained from the Iran\u0026apos;s medical system database (https://membersearch.irimc.org/) and provided them to the SP. This allowed the SP to refer to the desired pharmacist according to the picture. If the pharmacist was not present in the pharmacy, that pharmacy would be visited again.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCase Scenario:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eA female pharmacy student was chosen and given specialized training to act as an SP whose physical attributes closely resembled a pregnant woman\u0026apos;s. We provided education to our student regarding a 25-35 years old woman with a medical history of systemic lupus erythematosus. She was uncertain about taking a particular prescription medication during her ninth week of pregnancy. \u003cstrong\u003eFigure 1.\u003c/strong\u003e represents an overview and examples of potential responses a pharmacist might give to the SP.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eScoring Systems\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen assessing the quality of medication counseling, it is crucial to consider two key factors: logical questioning and providing accurate advice. An inductive approach was used to develop a comprehensive set of scoring criteria for evaluating the quality of medication counseling. This approach focused on two main categories: assessing the patient\u0026apos;s needs and providing clear instructions for medication use\u0026nbsp;(25).\u003c/p\u003e\n\u003cp\u003eThe expert panel designed the scoring system for this project. A general core was assumed for classifying the pharmacist\u0026apos;s questions, recommendations, and approach to the case. As a result, a scoring system was created for the fulfillment or non-fulfillment of each of the assumed items, which is provided in the supplementary file 2. Moreover, the SP scored the practice of the pharmacists immediately after leaving each visited pharmacy, evaluating them on a case-by-case basis.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eBias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe only invited individuals who fully met the eligibility criteria to address the selection bias. As knowledge and attitude have been assessed using scientific questions, we tend to reduce the risk of social desirability bias, which could occur if pharmacists altered their responses based on perceived expectations. In addition, the pharmacists were not informed of details regarding the SP\u0026rsquo;s identity, medical condition, or the specific timing of the visit. This lack of information was crucial in helping an unbiased assessment of their actual practice.\u003c/p\u003e\n\u003cp\u003eConsidering that pharmacies in Tehran serve an average of around 250 clients per day, and since the SP visit happened several days after the initial visit, the potential for recall bias was deemed minimal. To further address potential biases associated with the SP, she was rigorously trained to adhere strictly to a standardized script during visits, ensuring consistency in the interactions with pharmacists. By following this protocol, we aimed to closely replicate typical practice conditions, thereby reducing the likelihood of behavior modification resulting from the awareness of being observed. Furthermore, the scenario provided by the SP was not directly connected to the knowledge and attitude questionnaire, which diminished the possibility of bias.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cluster-stratified sampling was implemented to recruit community pharmacies from various regions of Tehran, specifically the northern, southern, eastern, western, and central areas. Within each region, a convenience sample of community pharmacies was utilized. The sample size was calculated using Cochran\u0026apos;s statistical formula, tailored to the study population. Our objective was to achieve a precision level of 7% within a 95% confidence interval, based on a target population of about 2,500 pharmacies. Considering that each pharmacy is associated with a single pharmacist in Iran, we determined that a minimum sample size of 182 pharmacists was necessary to meet this precision requirement.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was conducted using SPSS version 26 software. Descriptive statistics were reported as frequencies and means \u0026plusmn; standard deviation (SD). The Kolmogorov-Smirnov test was employed to assess the normality of the data distribution. To compare the sub-groups that existed in the characteristics of the participants, both the t-test and analysis of variance (ANOVA) were utilized. The Chi-Square test was applied to examine relationships between non-parametric variables. Additionally, Tukey\u0026apos;s Honestly Significant Difference (HSD) post-hoc test was conducted for multiple comparisons following ANOVA. The relationship between the average knowledge and performance scores of participants and the sub-groups of their characteristics was also assessed using the Chi-Square test. A significance threshold of \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 was set to determine statistical significance.\u003cstrong\u003e\u003cbr\u003e \u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe prototype questionnaire achieved a CVI of 0.82 and a Cronbach's alpha of 0.81 for 50 pharmacists. Within 284 pharmacy visits, 200 pharmacists completed the study per protocol. After a week, their practice was evaluated with the SP. Of the 84 participants excluded from the analysis, 48 decided not to participate, 17 did not finish the questionnaires, and 19 pharmacists were not available during the SP's visit. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. shows the flow diagram of participants in more detail.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOut of 200 included pharmacists, 68 were men, and 132 were women. Regarding the highest level of education, 92.5% had a PharmD, 6% had a PhD, and 1.5% had a B.Pharm. Detailed demographic data of the study participants can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of pharmacists (N\u0026thinsp;=\u0026thinsp;200).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubgroups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (33.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (17.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132 (66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharm.D.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185 (92.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePh.D.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB.Pharm.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eWork experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (39.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (34.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eYears since graduation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54 (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (14.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (11.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eUse of scientific resources and references\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnline resources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161 (80.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectronic information databases (UpToDate\u0026reg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95 (47.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. shows the results of the pharmacists' attitudes about the impact of utilizing electronic information databases. Many pharmacists (58%) believed that the references available in community pharmacies were inadequate for answering the patients' questions (Q1). Most pharmacists (95.5%) do not believe that having a lot of work experience and personal knowledge improves the quality of pharmacy practice (Q2). Most pharmacists (86.5%) believed that it becomes impractical to use medical resources to help clients when pharmacies are overcrowded (Q3). In addition, a majority of 65.5% believed that searching for information in scientific resources in the presence of the patient can cause cynicism among patients, while 22% had the opposite opinion (Q4). Likewise, 62.5% of pharmacists disagreed that a pharmacist's work experience is more efficient than searching with scientific resources. Conversely, 18.5% of pharmacists agreed with this statement (Q5). Pharmacists indicated it is important to consult reliable scientific resources to ensure the safe use of drugs during pregnancy and breastfeeding. They also agreed on the importance of pharmacists checking prescription drug interactions in community pharmacies (Q6, Q7). Most participants (71.5%) disagreed with the idea that guidance, counseling, and the use of credible scientific resources in pharmacies cause confusion and anxiety in patients (Q8). Most pharmacists (78.5%) believed that using scientific resources and EBM improves patients' satisfaction and adherence to pharmacotherapy (Q9).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe attitudes of pharmacists towards health services and EBM in community pharmacies.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1. Pharmacists' attitudes towards using references to answer patients' questions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83 (41.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116 (58%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2. Pharmacists' attitudes towards their knowledge and years of experience.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e191 (95.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3. Pharmacists' attitudes towards the impossibility of searching for answer patients' questions during the busy time of the pharmacy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e173 (86.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (11.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4. Pharmacists' attitudes towards patients' negative mentality towards pharmacist knowledge when referring to scientific resources.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (65.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5. Pharmacists' attitudes towards the effectiveness of work experience instead of referring to scientific resources.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (18.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e6. Pharmacists' attitudes towards the need to use scientific resources to check the risks of medicines during pregnancy and breastfeeding for all patients.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e199 (99.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7. Pharmacists' attitudes regarding the non-necessity of checking drug interactions by a pharmacist versus the examination of drug interactions by a physician.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8. Pharmacists' attitudes regarding anxiety and confusion in managing patients will change and reduce the acceptance of medications if the information is provided completely.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143 (71.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e9. Pharmacists' attitudes towards increasing patient satisfaction by using reliable resources to respond to patients.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e157 (78.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe results in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. indicate that many pharmacists did not utilize a suitable scientific resource and underperformed in obtaining the patient's medical history and making a proper clinical decision. Altogether, their practice was poor to moderate. The study found that pharmacists' practice scores ranged from 13 to 90 out of 100, averaging 50.34\u0026thinsp;\u0026plusmn;\u0026thinsp;21.35.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePharmacists' practice towards EBM implementation and taking past medical history.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1. Pharmacist statement about clinical management after taking a complete history.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (65.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (34.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2. Ask the SP's age.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e176 (88%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e3. Ask for past medical history.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e113 (56.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87 (43.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4. Writing notes while taking history.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (16%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e168 (84%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5. Ask for family health history.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (20.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e159 (79.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6. Ask about taking medications.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140 (70%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (30%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e7. Ask about a history of drug or food allergies.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e191 (95.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8. Quick selection and correct use of scientific and information resources.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (29.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e141 (70.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e9. Provide the proper clinical decision.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (30%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140 (70%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e10. Professional discipline in managing the SP. (Score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (11.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e11. Provide needed education in plain and understandable language for the SP. (Score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (38%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (46%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e12. Explain follow-up tips to the SP after clinical decision.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e158 (79%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e13. Receive educational feedback from the SP.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e191 (95.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e14. Overall practice assessment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (28.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (38.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (32.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery Good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eSP: Simulated patient\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe assessment of pharmacists' knowledge reveals that their overall score in EBM is 37.91\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4, signifying a range of weak to moderate proficiency. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. shows the relationship between knowledge scores and other study parameters.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationships between knowledge and practice scores with other variables.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubgroups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKnowledge Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePractice Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.22\u0026thinsp;\u0026plusmn;\u0026thinsp;16.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.042*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e48.2\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.047*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e39.80\u0026thinsp;\u0026plusmn;\u0026thinsp;12.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e53.0\u0026thinsp;\u0026plusmn;\u0026thinsp;23.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e40.00\u0026thinsp;\u0026plusmn;\u0026thinsp;14.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;20.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e37.20\u0026thinsp;\u0026plusmn;\u0026thinsp;19.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e48.1\u0026thinsp;\u0026plusmn;\u0026thinsp;21.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e37.44\u0026thinsp;\u0026plusmn;\u0026thinsp;14.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e50.4\u0026thinsp;\u0026plusmn;\u0026thinsp;21.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.997\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e38.39\u0026thinsp;\u0026plusmn;\u0026thinsp;16.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e50.3\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHighest level of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharm. D.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e38.17\u0026thinsp;\u0026plusmn;\u0026thinsp;15.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e50.3\u0026thinsp;\u0026plusmn;\u0026thinsp;22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.886\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePh.D.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e37.00\u0026thinsp;\u0026plusmn;\u0026thinsp;17.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e51.7\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB. Pharm.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e36.00\u0026thinsp;\u0026plusmn;\u0026thinsp;30.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e45.0\u0026thinsp;\u0026plusmn;\u0026thinsp;32.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eWork experience (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e37.95\u0026thinsp;\u0026plusmn;\u0026thinsp;13.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e46.5\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.038*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e35.49\u0026thinsp;\u0026plusmn;\u0026thinsp;15.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e49.4\u0026thinsp;\u0026plusmn;\u0026thinsp;21.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e40.15\u0026thinsp;\u0026plusmn;\u0026thinsp;18.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e55.4\u0026thinsp;\u0026plusmn;\u0026thinsp;21.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNumber of daily prescriptions dispensed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e36.35\u0026thinsp;\u0026plusmn;\u0026thinsp;15.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.047*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e51.7\u0026thinsp;\u0026plusmn;\u0026thinsp;21.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e36.60\u0026thinsp;\u0026plusmn;\u0026thinsp;14.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;21.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e35.05\u0026thinsp;\u0026plusmn;\u0026thinsp;13.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e53.1\u0026thinsp;\u0026plusmn;\u0026thinsp;22.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e46.51\u0026thinsp;\u0026plusmn;\u0026thinsp;20.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e56.8\u0026thinsp;\u0026plusmn;\u0026thinsp;21.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eUse of scientific resources and references\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnline resources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e35.51\u0026thinsp;\u0026plusmn;\u0026thinsp;15.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.032*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e46.2\u0026thinsp;\u0026plusmn;\u0026thinsp;21.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.018*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectronic information databases (UpToDate\u0026reg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e39.86\u0026thinsp;\u0026plusmn;\u0026thinsp;17.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e52.8\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;17.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;21.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnalysis of the study population revealed that younger and less experienced pharmacists, as well as those who used electronic clinical resources such as UpToDate\u0026reg;, showed better practice regarding SP. The results revealed that most pharmacists have a limited to moderate understanding of EBM. Subsequently, their clinical practice reflects this insufficient knowledge. There was a positive correlation between the number of prescriptions dispensed daily and the enhancement of pharmacists' knowledge. However, it did not significantly affect their practice. Subgroup analysis is also shown in detail in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents the first examination of the relationship between e-health literacy and KAP among Iranian CPs. We employed a mixed-methods approach that incorporated two components: a questionnaire designed by an expert panel to assess pharmacists' knowledge and attitudes, alongside an SPM to evaluate their practices. The novelty of our research is underscored by the critical influence that patient consultations with pharmacists can have on both maternal and fetal health, emphasizing the need for pharmacists to verify updated resources to support EBM.\u003c/p\u003e\u003cp\u003eOur findings indicate that Iranian pharmacists generally lack sufficient knowledge about available resources, which hinders their ability to search for and study valid and current publications. Furthermore, most pharmacists reported insufficient time as a key obstacle to utilize these resources properly within community pharmacy settings. Although the study found a generally positive attitude towards EBM among Iranian pharmacists, it is evident that many do not utilize electronic information databases and possess limited knowledge regarding them. A positive correlation was found between advanced levels of knowledge and enhanced practice among CPs. In addition, we discovered that those participants who utilized UpToDate\u0026reg; and online resources exhibited significantly improved knowledge and practices. These findings suggest that using reliable online resources may play a crucial role in the professional development of a pharmacist.\u003c/p\u003e\u003cp\u003eAdditionally, our results demonstrated a concerning trend: pharmacists' knowledge and familiarity with resources for addressing patients' medication needs tend to decline or remain static as they age. It can be inferred that older pharmacists often face multiple challenges such as inadequate facilities and limited opportunities for ongoing training, which may lead to a gradual decline of their knowledge and skills. However, younger pharmacists not only benefit from advanced scientific knowledge, but also demonstrated greater familiarity with reputable databases and references. In this study, most Iranian pharmacists held a PharmD degree, while others had a bachelor's degree or a PhD. However, no statistically significant difference was observed in knowledge levels across these educational attainment groups. Also, while the majority of surveyed pharmacists had less than five years of work experience, no correlation was identified between knowledge levels and work experience among pharmacists with \u0026lt;\u0026thinsp;30 years in the profession compared to other groups. Moreover, younger and less experienced pharmacists demonstrated higher knowledge and proficiency in clinical management.\u003c/p\u003e\u003cp\u003eSeveral studies have explored the impact of age and experience on EBM among healthcare professionals (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). A study conducted on 55 CPs in Jordan utilizing SPM, revealed that older pharmacists with extensive years of experience were more likely to provide necessary information proactively, without awaiting patient inquiries. In contrast, pharmacists with less than five years of experience and higher confidence levels were more inclined to respond when patients specifically sought information. Furthermore, research indicates that as more time elapses since graduation, the knowledge and skills of healthcare professionals may diminish (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This gap emphasizes the critical need for ongoing education in performing EBM and maintaining clinical expertise.\u003c/p\u003e\u003cp\u003eIt is worth mentioning that in a systematic review of 57 articles on physicians' KAP toward EBM, consulting with colleagues was recognized as the primary source of information for EBM. Interestingly, e-health services were reported as the least favored resource among physicians in this study (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In contrast, a study in the United States involving clinical assistants found that over 70% of participants preferred using online resources, indicating a potential shift towards the adoption of e-health platforms in clinical settings (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrevious studies have identified the primary resources that pharmacists usually rely on for finding clinical evidence, including international guidelines, textbooks, Wikipedia, Google Scholar, PubMed/Medline, Medscape\u0026reg;, The Database of Abstracts of Reviews of Effectiveness (Dare\u0026reg;), Cochrane\u0026reg;, EvidenceUpdates\u0026reg;, the Turning Research into Practice (Trip\u0026reg;), LexiComp\u0026reg;, Micromedex\u0026reg;, and UpToDate\u0026reg; (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The reliance on a diverse range of sources highlights the necessity for comprehensive training in the utilization of these tools. Furthermore, it implies that the accessibility to and familiarity with these resources may vary among pharmacists (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent research has recognized several barriers to the integration of EBM in routine practice. These barriers include time constraints, insufficient knowledge and skills, patient overload, chaotic work environments, lack of financial resources, inadequate facilities to ensure patient privacy, absence of an integrated communication framework within the healthcare system, incomplete access to patient records, insufficient societal awareness regarding the critical role of healthcare professionals, a focus on increasing product sales, inadequate motivation for time-consuming consultations, and restricted access to e-health platforms for pharmacists. Additionally, few articles have highlighted that a primary obstacle to utilizing scientific resources in daily practice is the lack of sufficient authority to modify patient care protocols and resistance to change (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study encountered several obstacles in the collection and reporting of relevant information that could potentially impact the results. The major challenges were the absence of pharmacists in certain pharmacies during the visits, an uneven distribution of community pharmacies across Tehran, patient overload, and difficulties in scheduling meetings with pharmacists. Another limitation of our study was the potential subjectivity in scoring by the SP. Furthermore, it is noteworthy that 63.5% of the participants were \u0026gt;\u0026thinsp;40 years old, and our sample size was limited. Consequently, it can be inferred that in a larger population, the actual level of knowledge and performance may be lower than what was reported in this study. Moreover, an important consideration is that since participants were required to be clearly informed of the study's objectives, the SP's visits were scheduled over a one-week period following their responses to the questionnaires. This timing raises the possibility that pharmacists may have performed better solely during this specific timeframe, potentially influencing our results. To mitigate this bias, future studies should consider implementing a longer observation period, randomizing the scheduling of visits, and employing different SPs simultaneously to better assess the pharmacists' knowledge and performance across varying conditions. In addition, incorporating a diverse range of assessment methods could provide a more comprehensive evaluation of pharmacists' competencies and help identify specific areas for improvement.\u003c/p\u003e\u003cp\u003eGiven the current challenges within Iran's pharmaceutical system, many pharmacists may not follow EBM in their daily practice or may not be sufficiently familiar with the tools that support this approach. Our study showed that using electronic information databases like UpToDate\u0026reg; improved pharmacists' knowledge scores and helped them make more evidence-based decisions. This finding implies that utilizing these valuable resources can bridge the gap between the attitude and actual implementation of EBM in community pharmacies. In this case, the results of our study could alert health policymakers to consider clearer frameworks to enhance the knowledge and performance levels in critical aspects of the health, such as medication consumption during pregnancy, and to address existing barriers to ultimately improve patient quality of life. Further studies are warranted to explore the KAP of Iranian CPs regarding the impact of scientific resources and e-health tools in clinical appraisal by using more standardized questionnaires and more rigorous methodologies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study has revealed that although pharmacists have a positive attitude towards incorporating EBM into their professional practice, there is still a substantial potential and scope for improvement in their knowledge and practice. Meanwhile, those pharmacists who utilized UpToDate\u0026reg; demonstrated superior knowledge and practice. Moreover, a positive correlation was observed between higher levels of knowledge and improved practice among pharmacists.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were completed under the principles of the Declaration of Helsinki. The Ethics Committees of Shahid Beheshti University of Medical Sciences approved the study protocol during a regular session (IR.SBMU.PHARMACY.REC.1399.212.). A verbal informed consent was obtained from the participants. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the procedure for obtaining verbal informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data analyzed during this study is provided within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHE designed the SP and study plan, HP searched the databases and extracted the desired data, GM categorized the data, HE conducted the statistical analysis and extracted the interpreted the results, and HP and GM drafted the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe want to thank the Student Research Committee of Shahid Beheshti University of Medical Sciences for its support in providing the ethical code.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSato N, Fujita K, Kushida K, Chen TF. Development and consensus testing of quality indicators for geriatric pharmacotherapy in primary care using a modified Delphi study. Int J Clin Pharm [Internet]. 2022;44(2):517\u0026ndash;38. Available from: https://doi.org/10.1007/s11096-022-01375-x\u003c/li\u003e\n \u003cli\u003eLelie-van der Zande R, Koster ES, Teichert M, Bouvy ML. Barriers and facilitators for providing self-care advice in community pharmacies: a qualitative study. Int J Clin Pharm [Internet]. 2023;45(3):758\u0026ndash;68. 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Journal of Pharmacy \u0026amp; Pharmaceutical Sciences [Internet]. 2024;Volume 27-2024. Available from: https://www.frontierspartnerships.org/journals/journal-of-pharmacy-pharmaceutical-sciences/articles/10.3389/jpps.2024.12302\u003c/li\u003e\n \u003cli\u003eNewman T V, San-Juan-Rodriguez A, Parekh N, Swart ECS, Klein-Fedyshin M, Shrank WH, et al. Impact of community pharmacist-led interventions in chronic disease management on clinical, utilization, and economic outcomes: An umbrella review. Research in Social and Administrative Pharmacy [Internet]. 2020;16(9):1155\u0026ndash;65. Available from: https://www.sciencedirect.com/science/article/pii/S1551741119305534\u003c/li\u003e\n \u003cli\u003eMohammadnezhad G, Ehdaivand S, Sebty M, Azadmehr B, Ziaie S, Esmaily H. Chronic kidney disease and adherence improvement program by clinical pharmacist-provided medication therapy management; a quasi-experimental assessment of patients\u0026rsquo; self-care perception and practice. BMC Nephrol [Internet]. 2024;25(1):463. Available from: https://doi.org/10.1186/s12882-024-03902-6\u003c/li\u003e\n \u003cli\u003eLelie-van der Zande R, Koster ES, Teichert M, Bouvy ML. Barriers and facilitators for providing self-care advice in community pharmacies: a qualitative study. Int J Clin Pharm [Internet]. 2023;45(3):758\u0026ndash;68. Available from: https://doi.org/10.1007/s11096-023-01571-3\u003c/li\u003e\n \u003cli\u003eWalle AD, Demsash AW, Adem JB, Wubante SM, Shibabaw AA, Mamo DN, et al. Exploring facilitators and barriers of the sustainable acceptance of e-health system solutions in Ethiopia: A systematic review. PLoS One. 2023 Aug 1;18(8 August).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Evidence-Based Medicine, Public Health, Pharmacy Practice, Health Services Research","lastPublishedDoi":"10.21203/rs.3.rs-6557624/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6557624/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e Evidence-based medicine (EBM) uses the most reliable evidence available to enhance decision-making in patient care, thereby improving the treatment plan success, patient compliance, rational use of medications, and reducing healthcare costs.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003c/em\u003e This study evaluated the knowledge, attitude, and practice of Iranian pharmacists regarding EBM utilization in community pharmacies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e A 36-item questionnaire was designed and validated to assess the knowledge and attitudes of community pharmacists. A simulated-patient method was used to evaluate the practice one week after completing the questionnaire. \u003cem\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003c/em\u003eWithin 284 pharmacy visits, the results of 200 pharmacists were collected entirely. Pharmacists aged 24-65 were included in the study. The average knowledge score of pharmacists was 37.91±15.4 out of 100. The pharmacists aged 24-29 demonstrated higher knowledge levels than pharmacists aged 30-65 (\u003cem\u003eP\u003c/em\u003e=0.042). Furthermore, those who dispensed more than 30 prescriptions daily showcased a higher knowledge level (\u003cem\u003eP\u003c/em\u003e=0.024). Additionally, it was found that pharmacists who utilized UpToDate® exhibited greater knowledge and practice in comparison to others who did not use this clinical resource (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Most pharmacists had a positive attitude towards EBM and its implementation in the pharmacy (99.5%). The mean score of practice in managing the simulated-patient was 50.34 ± 21.35. A direct association was detected between knowledge and practice (r=0.73, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). There was no association between pharmacists' attitudes and their practice scores.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003e\u003c/em\u003eMost pharmacists agreed about the crucial need to incorporate EBM into pharmacy practices. Pharmacists with advanced knowledge of EBM and using UpToDate® showed better knowledge and practice.\u003c/p\u003e","manuscriptTitle":"Exploration of Utilizing Electronic Health Databases in Evidence-Based Practice Among Iranian Pharmacists: A Survey by Simulation of Health-seeking Pregnant Women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-22 08:17:37","doi":"10.21203/rs.3.rs-6557624/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fee68d4-2e71-4fec-8720-31e0b861153c","owner":[],"postedDate":"July 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:01:58+00:00","versionOfRecord":{"articleIdentity":"rs-6557624","link":"https://doi.org/10.1186/s40780-026-00561-7","journal":{"identity":"journal-of-pharmaceutical-health-care-and-sciences","isVorOnly":false,"title":"Journal of Pharmaceutical Health Care and Sciences"},"publishedOn":"2026-04-02 15:58:40","publishedOnDateReadable":"April 2nd, 2026"},"versionCreatedAt":"2025-07-22 08:17:37","video":"","vorDoi":"10.1186/s40780-026-00561-7","vorDoiUrl":"https://doi.org/10.1186/s40780-026-00561-7","workflowStages":[]},"version":"v1","identity":"rs-6557624","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6557624","identity":"rs-6557624","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}