The Military Service Identification Tool - Main Report
Abstract: This research used an electronic health record (EHR) Case Register to explore the utility and feasibility of identifying veterans who accessed secondary mental health care services within the UK. The identification of veterans was validated by contacting patients classified as veterans/civilians and confirming their status via self-reported surveys. In addition, the report compared the sociodemographic profiles and the types of mental health diagnoses among veterans who engage in secondary mental health care services compared to their matched civilian counterparts. Analyses indicated that SLaM veterans were significantly more likely to live alone and to be single than Combat Stress veterans. Combat Stress veterans were significantly more likely to live with their partner/children and to be in a relationship than SLaM veterans. Combat Stress veterans were significantly more likely to be of British ethnicity than SLaM veterans. SLaM veterans were significantly more likely to be given a drug disorder diagnosis, whereas Combat Stress veterans were significantly more likely to be given a depressive, anxiety, stress or alcohol disorder diagnosis.
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