Beers Criteria Medication Review

When to Use This Skill

Use when reviewing medications for patients age 65 and older to identify potentially inappropriate prescriptions per AGS Beers Criteria 2023.

Clinical Workflow

1. Use fhir_read to confirm patient age >= 65 from Patient.birthDate
2. Use fhir_search to pull all active MedicationRequest resources
3. Use fhir_search to pull active Condition resources for drug-disease interaction screening
4. Use fhir_search to pull recent Observation resources (renal function for dose adjustments)
5. Screen each medication against Beers Criteria categories: medications to avoid regardless of diagnosis, medications to avoid with specific conditions, medications to use with caution, drug-drug interactions to avoid, dose adjustments based on renal function
6. Present findings with Beers category, quality of evidence, strength of recommendation, and safer alternatives

FHIR Resources

• Patient -- Age verification (must be >= 65)
• MedicationRequest -- Active medications to screen
• Condition -- Active diagnoses for drug-disease interaction screening
• Observation -- Renal function (eGFR/CrCl) for dose-based criteria

FHIR Query Examples

Pull Active Medications

fhir_search(resourceType="MedicationRequest", queryParams="patient=[patient-id]&status=active&_count=100")

Pull Active Conditions

fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&clinical-status=active")

Pull Renal Function

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=33914-3&_sort=-date&_count=1")

Clinical Guidelines

• AGS Beers Criteria 2023 (American Geriatrics Society)
• STOPP/START Criteria v2 (Screening Tool of Older Persons' Prescriptions / Screening Tool to Alert to Right Treatment)
• CMS Part D medication therapy management requirements

Interpretation Guide

• Classify findings by Beers category: Table 2 (avoid regardless), Table 3 (avoid with specific conditions), Table 4 (use with caution), Table 5 (drug-drug interactions), Table 6 (dose adjustment for renal function)
• Rate evidence quality: High, Moderate, Low, Very Low
• Rate recommendation strength: Strong Avoid, Conditional Avoid, Use with Caution
• For each flagged medication, provide: the Beers concern, the clinical rationale, safer alternative options, and whether discontinuation requires a taper

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges