This impact report, focusing on activities and change against its theory of change during its 2019 - 2022 strategy period. The report, by Tiller Research Ltd, highlights outcomes and changes under the Alliance's four linked areas of impact, partnership, practice, research and policy. These areas were identified in the Alliance's 2018 consultation, which recommended that the Alliance focus on connecting practitioners, policy makers and researchers with each other, with evidence and with support. The report celebrates the Alliance's impact on policy developments and its achievements in building and supporting a thriving UK-wide network of research-practice Hubs, connecting 891 professionals in 12 Hubs hosted by 21 partners working to do together for Service children what they cannot do alone.
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