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South Texas Veterans Health Care System (STVHCS)

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GRECC Clinical Program

Sara E. Espinoza
Sara E. Espinoza, MD, MSc 
Associate Director for Clinical Programs
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The San Antonio Geriatric Research, Education and Clinical Center (GRECC) has a strong commitment to improving the care of older Veterans in South Texas. We work together with Geriatrics and Extended Care (G/EC) to conduct clinical demonstration projects (CDPs) and quality improvement projects, all aimed at developing better ways to care for older Veterans.

Goals of GRECC Clinical Program

  1. Develop and disseminate innovative models of care for older adults, across a spectrum of social and physical functioning, from robust to frail.
  2. Conduct clinical and health services research, centered on G/EC clinical programs, to better understand and characterize the needs of our older Veteran patient population.
  3. Provide a robust clinical and research environment for clinical training and research education of trainees in geriatric medicine at multiple levels (students, residents, and fellows).

Current Clinical Demonstration Projects

  • Dementia Caregivers Support & Education Program – Monthly program to support those caring for our Nation’s heroes with Dementia. The program consists of monthly classes that cover Dementia related topics using a personalized approach. These group sessions allow caregivers to exchange experiences and receive coping tips on Dementia related topics. In collaboration with Geriatrics and Extended Care (GEC) the GRECC offers support for family caregivers, stress management techniques, and relaxation and coping in a confidential environment. The classes welcome caregivers of Veterans with Dementia, Veterans caring for loved ones who have Dementia and VA staff caring for patients or relatives with Dementia. Sara Espinoza, MD, MSc, a geriatrician leads this project.
  • Enhancing Quality of Prescribing Practices among older Veterans discharged from the Emergency Department (EQUIPPED) – A multi-site program to reduce potentially inappropriate medications prescribed to older Veterans seen in the Emergency Department (ED). The SA GRECC, in collaboration with the Pharmacy Department, recently implemented this innovative model at the Audie L. Murphy Memorial VA Hospital. By providing education to ED providers who treat older Veterans and tailored clinical order sets, EQUIPPED has been successful at several other VA facilities in improving the quality of prescribing practices among VA.
  • Geriatric Medicine Education at Discharge (GMED) – A post-discharge interdisciplinary pharmacological intervention in high risk older Veterans following admission at the Audie L Murphy Division of the South Texas Veterans HealthCare System (STVHCS). Modeled after the very successful PILL program at the VA Boston Healthcare System, this enhanced medication education upon discharge includes follow up medication reconciliation and face-to face visits. Sara Espinoza, MD, MSc, a geriatrician leads this project.
  • GRECC Connect – This geriatrics telehealth program is a 13-site project that helps connect Veterans in rural areas with geriatric care and services. GRECC Connect helps Veterans that don’t have a geriatrician in their area and/or live too far for comfortable travel to the Audie L. Murphy VA Hospital in San Antonio. The geriatrics team works alongside the Veteran’s VA primary care provider (PCP) to optimize their health. The team includes a geriatrician, nurse, pharmacist and social worker with referrals to nutritionist, geriatric psychiatrist, physical and occupational therapists available if needed. Using this program helps avoid unnecessary travel, saves time and travel cost, may help avoid additional copays and reduces wait time to see a geriatrician or get a second opinion. Sara Espinoza, MD, MSc, a geriatrician leads this project.
  • Walking Clinic – in collaboration with the Little Rock GRECC this project targets elderly veterans who may have an inactive or sedentary lifestyle which has negative effects on physical and mental health, quality of life and healthcare cost. This service is a comprehensive approach to assess, educate, motivate, and encourage these veterans to commit to engage in regular walking. Through tailored counseling with the veterans and/or their family we believe this project will increase the number of elderly Veterans that engage and maintain a regular regiment of walking increasing their stamina and promoting health benefits. Dean Kellogg, MD leads this project.
  • Former Prisoner of War Clinic The VA Health Care System is mandated to provide priority treatment for Former Prisoners of War (FPOWs). Surprisingly, a significant number of FPOWs do not avail themselves of the benefits to which they are entitled. The goal of this project is to develop a new interdisciplinary team dedicated to increasing the involvement of FPOWs in the VA Health Care System. In 2017, the VA National Advisory Committee on Former Prisoners of War traveled to the STVHCS to explore the FPOW Clinic concept and to directly observe its operations. As a result of this visit, the Committee endorsed the concept and has recommended that the STVHCS GRECC FPOW clinic serve as a model for FPOW care throughout the VA system. This project is led by Dr. Dean Kellogg Jr.     Former Prisoner of War Clinic Training Manual