Abstract: This report draws to a conclusion the trial phase of the Future Horizons Programme (FHP) and considers 18 months of data from the Catterick cohort. This includes Early Service Leavers (ESLs) from both the Infantry Training Centre (ITC) and trained soldiers from units stationed within and around Catterick Garrison, North Yorkshire. Following the successful findings published in the 12 month evaluation report [1], the MOD have made a commitment to roll the FHP out across all three services. The conclusions drawn in the 12 month evaluation report suggest that there should be a high degree of fidelity to the FHP model of service delivery. Given the differences in structure and function peculiar to aspects of the single services and between the different branches of the armed services, the roll-out of the FH Programme will have to take all of these nuances into account. It is hoped that some of the observations made in this final report will contribute to the successful delivery of the FHP, so that ESLs have a mechanism of support when they leave Her Majesty’s Armed Services.
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