JSP 534 The Tri-Service Resettlement and Employment Support Manual Part 1: Directive
Summary: JSP 534 is intended as the authoritative document for tri-Service resettlement and employment support policy and procedures throughout Defence and within the 3 Services. It is designed to be used by staff responsible for providing resettlement and employment support to Service leavers (SL) but must also be available to SL themselves. This JSP contains the policy and direction on Tri-Service Resettlement and Employment Support. Part 2 of this JSP contains guidance on the processes involved and best practice to apply this policy. This JSP will be reviewed at least annually and any significant changes will be endorsed at the Training, Education, Skills, Recruitment and Resettlement Policy and Assurance Group (TESRR PAG).
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