Improving Veterans MSK Rehabilitation Final Report
Summary: Musculoskeletal conditions are the most common medical reason for discharge from the armed forces. Many of the injuries sustained in combat can result in loss of limbs requiring amputation and prosthetics. Exposure to complex loads during training and active service can also cause biomechanical deficits which leads to a high level of hip and groin pain. These issues may develop into long-term health problems. When transitioning from the armed forces, veterans lose access to gold standard musculoskeletal (MSK) rehabilitation. During their service, they are covered by the Defence Medical Service run by Ministry of Defence (MOD), an occupational-based healthcare system with excellent purpose-built facilities and no waiting lists or complicated referral systems, in which the medical staff understand the types of injuries and illnesses that arise from active service. On leaving the service, veterans with MSK injuries or conditions find themselves in a very different world. They have to access and navigate NHS services, which can be difficult, especially for those with chronic ongoing needs that relapse periodically and deteriorate with time. This report reviews current MSK rehabilitation services for veterans and provides recommendations for a model of care that is more person-centred and holistic.
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