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Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity). Supported well, telemedicine can particularly improve patient satisfaction, health outcomes, and equity. Implemented poorly, telemedicine can facilitate unsafe care, worsen disparities, and waste resources. Without further action from lawmakers and agencies, payment will end for many telemedicine services currently used by millions of Americans at the end of 2024. Policymakers, health systems, clinicians, and educators must decide how to support, implement, and sustain telemedicine, and long-term studies and clinical practice guidelines are emerging to provide direction. In this position statement, we use clinical vignettes to review relevant literature and highlight where key actions are needed. These include areas where telemedicine must be expanded (e.g., to support chronic disease management) and where guidelines are needed (e.g., to prevent inequitable offering of telemedicine services and prevent unsafe or low-value care). We provide policy, clinical practice, and education recommendations for telemedicine on behalf of the Society of General Internal Medicine. Policy recommendations include ending geographic and site restrictions, expanding the definition of telemedicine to include audio-only services, establishing appropriate telemedicine service codes, and expanding broadband access to all Americans. Clinical practice recommendations include ensuring appropriate telemedicine use (for limited acute care situations or in conjunction with in-person services to extend longitudinal care relationships), that the choice of modality be done through patient-clinician shared decision-making, and that health systems design telemedicine services through community partnerships to ensure equitable implementation. Education recommendations include developing telemedicine-specific educational strategies for trainees that align with accreditation body competencies and providing educators with protected time and faculty development resources., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction: While driving is an important instrumental activity of daily living (ADL), older adults belonging to low-income racial minorities make up a large proportion of never-drivers who utilize alternative modes of transportation (Babulal et al., Geriatrics 3, 2018; Choi and Mezuk, J Appl Gerontol 32:902-912, 2013). Our study is a comparative analysis of comorbid health conditions among older drivers and nondrivers receiving care at a safety net hospital in Atlanta in order to assess utilization of healthcare resources and chronic disease burden among the two groups., Methods: This is a retrospective cohort study of 690 patients age 65 or older who received care at the Emma Darnell Geriatric Center at Grady Hospital during 2/1/2016-2/1/2017. Self-reported driving status was analyzed and compared for all variables including demographics, insurance information, ADL scores, use of assistive device, sensory impairment, number of Geriatric Clinic visits in a year, and associated visit diagnoses., Results: Twenty-three percent of total 690 patients reported being drivers. Over 94% patients were African Americans and over 67% were women in both groups. Drivers were more functionally independent and were less likely to have cognitive impairment compared with nondrivers. Mean number of visits to Geriatric Primary Care Clinic in a year was low in both groups, and enrollment in a Medicare advantage plan did not affect the association., Conclusion: Approximately 77% of older adults getting care at a safety net hospital in Atlanta reported not driving a motor vehicle. Utilization of primary healthcare resources was low in both groups and was not affected by enrollment in a Medicare advantage plan.

Aquifer Geriatrics, formerly web-based Geriatrics Education Modules, was initially developed through Donald W. Reynolds Foundation funding, and is now the national curriculum of the American Geriatrics Society and the Association of Directors of Geriatric Academic Programs. Aquifer Geriatrics consists of 26 evidence-based, peer-reviewed, online case-based modules based on the Association of American Medical Colleges/John A. Hartford Foundation Minimum Geriatrics Competencies for Medical Students and is available by subscription at www.aquifer.org/courses. This curriculum aims to help address the national shortage of geriatrics educators, complement current teaching, bridge content gaps in geriatrics education, and standardize geriatrics-focused educational content. This report will describe the development of Aquifer Geriatrics, highlight best practices to incorporate cases in a variety of teaching settings, describe teaching methods that utilize the curriculum to create a robust experience for learners, and address the cost of obtaining the curriculum. J Am Geriatr Soc 67:811-817, 2019., (© 2019 The American Geriatrics Society.)