Abstract
BACKGROUND: Evidence-based medicine (EBM) applies the most reliable evidence available to support clinical decision-making, improving treatment outcomes, rational medication use, and reducing healthcare costs. OBJECTIVES: This study evaluated the knowledge, attitude, and practice (KAP) of Iranian community pharmacists regarding EBM utilization. METHODS: A 36-item questionnaire was designed and validated to assess the pharmacists’ knowledge and attitudes toward EBM. Practice was evaluated using a simulated-patient method one week after questionnaire completion. Multivariable linear regression was used to examine associations between pharmacist characteristics and knowledge and practice scores, with sensitivity analyses adjusting for geographic region. RESULTS: Within 284 pharmacy visits, data were obtained from 200 pharmacists aged 24–65 years. The average knowledge score was 37.91 ± 15.4 (out of 100). Pharmacists aged 24–29 demonstrated higher knowledge levels than those aged 30–65 (P = 0.042). Dispensing more than 30 prescriptions daily was associated with higher knowledge scores (P = 0.024). Pharmacists who reported using UpToDate(®) demonstrated higher knowledge and practice scores compared with non-users (P < 0.001). Attitudes toward EBM were overwhelmingly positive, indicating strong theoretical support despite reported implementation barriers. The mean practice score 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), whereas no association was observed between attitudes and practice. Multivariable analysis showed that younger age, higher prescription volume, and use of UpToDate(®) were independently associated with higher knowledge and practice scores. CONCLUSION: Most pharmacists support EBM; however gaps in knowledge and practice remain. Use of structured electronic resources such as UpToDate(®) were associated with improved knowledge and practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40780-026-00561-7.