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Difficult situation 4 : A patient reports their pain medication as lost or stolen. Advice : It is not unusual for a patient to report to their prescribing clinician that they have discovered that their prescription pain medication or the written prescription has been either lost or stolen, leading them to request a new prescription. Losing a prescription form or a vial of medications may result from the occasional lapses that all patients may have.

If this occurs only once it may not have significant medical implications, and the prescriber may choose to replace it without much concern.

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Losing a medication more than once, however, may imply that something else is going on. There are many possibilities.

Is the patient experiencing some type of cognitive impairment, perhaps one that is being made worse by the medication? Does the patient need a further neurological evaluation?


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Is the patient impaired by the use of other substances? Should a urine drug screen and some simple labs including CBC, metabolic panel, and thyroid function studies, be done even as early as the first incident of a lost prescription?


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  • Is the patient misusing the prescription and running out of it early because they are taking more than prescribed, giving it away, or selling it? Taking a consistent approach to a lost prescription is made much easier if the provider has reviewed their policy about this with the patient ahead of time. Based on our early experience, Stella Safo, a physician leader, and Bruno Silva, an interaction designer, collaborated to build a real-time patient engagement tool that we are replicating in other settings.

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    Listen to other organizations. While this makes sense in theory, how do you address these broad needs in practice? In designing our program, we made a point of visiting exemplary organizations including Oak Street Health , CareMore Health System , and Iora Health to find out how they handled this challenge.

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    We now use a similar worry-score system in our Peak Health clinical service so that the entire team spends more time focusing on the people who require the most attention on any given day, rather than just those who came to the clinic that day. We have early data showing that applying what we have learned from our top-performing peer organizations is translating into better care, lower costs, and higher patient and provider engagement.

    Listen to colleagues.

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    To tap expertise throughout Mount Sinai Health System, over the past year Natalie Privett, a colleague with an industrial engineering and learning background, has created a learning network called the Ambulatory Care Transformation ACT Network. It would have been much harder to go the other way around, trying to implement textbook care models from the top down, rather than allowing them to be developed from the bottom up through a learning network.

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    In a fast-paced health care system, it is clear that patients will benefit from the work of researchers and technologists focused on data-driven technologies to improve care. Organizational culture. The highest-need patients are the least likely to be heard.