Collaborative Practice in Oral Nutritional Supplement Provision: The Critical Role of Pharmacists in the Patient Journey

Background/Objectives: Disease-related malnutrition affects millions of patients worldwide. Nutrition support therapy (NST), namely oral nutritional supplements (ONS), serve as a cornerstone therapeutic intervention. However, treatment effective-ness depends not only on appropriate prescription but also on patient acceptance and adherence. This study evaluates the provision pathway of ONS within a co-payment healthcare system, focusing on patient acceptance patterns, barriers to adherence, and the critical yet underexplored role of pharmacist-patient interactions in determining treatment outcomes. Methods: A cross-sectional observational study was conducted across 100 Croatian community pharmacies during September-October 2025. Pharma-cists prospectively documented 973 patient encounters involving ONS prescriptions requiring co-payment using real-time patient record forms. Data captured patient demographics, diagnoses, prescription patterns, prior knowledge of co-payment re-quirements, acceptance responses, and pharmacist-assessed reasons for refusal. Re-sults: While 65% of all patients knew about co-payment requirements in advance, 51% of first-time users arrived uninformed, leading to dramatically different acceptance patterns (93% immediate acceptance when informed versus 33% when uninformed, p< 0.05). Overall, 8-12% of patients refused or reduced prescribed ONS. Among refus-als, 59% cited financial burden, but critically, 23% appeared not to understand why ONS was prescribed or what benefits to expect, revealing significant communication gaps in the care pathway. Fifteen percent of patients overall required pharmacist ex-planation before accepting their prescription, demonstrating pharmacists' decisive role as gatekeepers of nutritional therapy. Conclusions: Successful ONS provision requires enhanced collaborative practice across prescribers, pharmacists, and patients or their families. Key interventions include comprehensive prescriber-patient communication about co-payment and clinical rationale, specialized pharmacist education in dis-ease-specific nutrition and ONS counseling, and systematic communication protocols between prescribers and pharmacists. The pharmacy dispensing encounter represents an important decision point, where insufficient preparation and coordination may lead to avoidable treatment failures among vulnerable patient populations.