Strengthening and Empowering Delivery of the Covenant
Summary: This interim report summarises the findings of the summative evaluation of Phases I and II of the Strenghtening Delivery Programme [SDP], and draws out recommendations for the Armed Forces Covenant Fund Trust and Local Authorities. The evaluation findings strongly indicate that the SDP funding has had a significant positive impact on delivery of the Covenant. Questionnaire and interview responses also articulated areas of continued need, including areas where grant-holders felt they lacked support, or in which continued effort is required. Based on these findings, the study team identified several areas where both LAs and the Trust could better enable delivery of the Covenant.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P