Abstract
BACKGROUND: Many osteoarthritis patients incorporate dietary supplements and nutraceuticals into their self-management strategies. Community pharmacists play a pivotal role in patient education by identifying potential drug interactions and guiding the evidence-based and safe use of dietary supplements. This study aims to assess the real-world practice of Iranian pharmacists in managing osteoarthritis, with a specific focus on dietary supplement counseling, using the mystery shopper method. METHODS: This cross-sectional study was carried out in 225 active community pharmacies. Two female mystery shoppers performed a two-step scenario. In the first step, the mystery shopper requested an avocado/soybean supplement for knee pain from the pharmacist. In the second step, if the pharmacist did not inquire about the consumer or their medication history, the mystery shopper stated that the supplement was intended for her 64-year-old father, who was taking warfarin. All conversations were audio-recorded, and the pharmacists' practice was documented. RESULTS: Only 15 pharmacists inquired about the intended user. During step 1, only seven pharmacists successfully identified the potential warfarin- avocado/soybean interaction. In step 2, after receiving additional patient-specific details, the recognition rate increased to 29 pharmacists. However, no pharmacists provided further information about additional interactions, adverse effects, or contraindications related to avocado/soybean supplements. Only the seven pharmacists explained how to use the avocado/soybean supplement, while nine pharmacists obtained medical history, and eight pharmacists gathered medication history. CONCLUSION: Pharmacists provide limited and insufficient counseling on dietary supplements for osteoarthritis, highlighting a significant gap in patient education and the safe use of dietary supplements.