Table 3 Added value (convenience of use) of the tool

Ambulatory

Yerevan (Armenia)

“…The approach proved suitable for use in case of unavoidable exposure to FFCm’s contaminating the legal chain for example essential medicines (antibiotics)… and deliberate purchases from uncontrolled sources …”.

Ambulatory

Zagreb& Pula (Croatia)

“…Systematic approach for the identification of risk factors… it justifies the consideration of alternative diagnosis; opportunity for counselling of patient (preventative role)....

…additional anamnestic questions increased the duration of the consultation on average 6. 2 min (range: 3. 2- 11.4 min).

However this time should not be considered a mere prolongation of the consultation: it helps establish the suspicion of possible “poisoning” which by itself has to be clarified thoroughly.

Physicians have an inherent and professional interest to understand the nature of the observed symptom. Our questionnaire only helps do that. ”

Ambulatory

Rome (Italy)

“…The decision aid is useful to find patients at risk, combining known risk factors with the medical history of individual patients; but also offering alternatives for possible diagnosis (“differential diagnosis options”) to document and justify further diagnostic interventions....

The present observational study, though small, showed the existence of unsafe use of medicines (like phosphor-diesterase inhibitors), consumption of psychoactive substances and substances with a doping effect, as well as the indiscriminate use of dietary supplements which possibly cause disabling symptoms and a medical referral. …We can say that the protocol adopted here is potentially useful to define not only the characteristics of subjects potentially at risk for the use and abuse of medicines in the differential diagnosis of a condition possibly iatrogenic but also useful to identify with greater specificity the need for further investigation diagnostics.

The use of the decision aid requires 20–30 min.

It is most important is that the physician does not question the patient in a ”sterile manner“ but tries to understand personal motivation (problems) through direct and indirect questions ….”.

Pilot-study

Ambulatory

Belgrade (Serbia)

“…Health care settings with easy access (primary care) and mid to long- term trusted relationship are suitable…”

…Welcome the decision aid: this is, for the first time, a tool set up specifically for doctors. The primary care sector, such as family doctors, who are easy to access and have usually a longer-term, trusted relation with the patients, is well positioned to find patients at high risk of health damage by medicines produced and distributed outside the legal chain such as counterfeit (falsified) medicinal products…..

…In consultations, time is limited: risk status output needs to be integrated into patients’ questioning (anamnesis)…”.

In-patient Aalst (Belgium)

“….The decision aid gives an important reminder to the doctor – to take into account in treatment decisions and risk prevention, adverse reactions caused by FFC products; it could be a useful complement ….

…Manual scoring (used in this observational study setting) is impractical in real-life situation…..”

In-patient Reykjavík (Iceland)

“…There is no doubt that the topic of this project is very important. In my opinion it is more important that doctors always bear this in mind and include questions on the use of alternative medicines and/or counterfeit medicines. The consultation tool does not seem to be cost effective for use in unselected patients presenting in a general practice or in a gastroenterology clinic.

…Biomarkers (of health damage caused by FFC products) are needed …”.