Practice Guidelines
Quick links:
Medical Guidelines,
Behavioral Health Guidelines
Oral Health Guidelines
Guideline Adoption and Recommended Use
PacificSource Community Solutions, PacificSource Medicare, and PacificSource Health Plans supports the use of practice guidelines that are based on nationally recognized, valid, and reliable evidence-based clinical literature or a consensus of professionals in a particular field. PacificSource adopts medical and behavioral health guidelines to assist providers and members in making decisions about appropriate healthcare choices. PacificSource practice guidelines are not meant to replace the clinical judgment of a treating provider. Guidelines are reviewed and updated as needed on an annual basis.
In all cases, benefit determinations should be based on the applicable contract coverage. Should there be any discrepancy between these guidelines and the contract language, the contract language will take precedence.
Medical Guidelines
Asthma
2011 NHLBI and NAEPP: Asthma Care Quick Reference - Diagnosing and Managing Asthma
Coronary Artery Disease
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults - American Heart Association, 2013
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (PDF)
2017 ACC/AHA/HFSA Focused Update for Management of Heart Failure
COPD
2017 GOLD: Management and Prevention of COPD
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available from:
http://goldcopd.org.
Diabetes - Adult (Type I & II and Gestational), Child and Adolescent (Type I & II)
ADA Standards of Medical Care in Diabetes - 2018
AACE Comprehensive Type 2 Diabetes Management Algorithm - 2018
Heart Failure
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guidelines for the Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America, April 2017
Immunizations and Preventive Services
CDC Catch-Up Immunization Schedule for Persons Aged 4 Months Through 18 Years Who Start Late or Who Are More Than 1 Month Behind, 2018
CDC Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018
CDC Adult Immunization Schedule, 2018
CDC Guidelines for Vaccinating Pregnant Women, 2018
CDC Clinical Preventive Services Infant, Children and Adolescents, 2014
CDC Vaccines for your Children: Protect Your Child at Every Age, 2016
U.S. Preventive Services Task Force: Recommendations for Primary Care Practice
Obesity - Adult
Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults, 2016
Guidelines for the Management of Overweight and Obesity In Adults, 2013
Pain
CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016
Oregon Pain Guidance: Pain Treatment Guidelines, 2016
Prenatal Care - Routine
ACOG Term Birth Guidelines
Breastfeeding Guidelines CDC 2018
Compendia
NCCN Drugs and Biologics
Micromedex
Behavioral Health Guidelines
ADHD
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents - American Academy of Pediatrics, 2011
Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/ Hyperactivity Disorder, American Academy of Child and Adolescent Psychiatry, 2007
Alcohol Abuse Screenings and References
Alcohol Use Disorders Identification Test (AUDIT) - Interview Form (PDF) - PacificSource covers the use of this screening tool. Please use CPT code 99408.
Alcohol Use Disorders Identification Test (AUDIT) - Self-Report Form (PDF)
AUDIT: Guidelines for Use in Primary Care, Second Edition (PDF) - World Health Organization, Department of Mental Health and Substance Dependence
A Pocket Guide for Alcohol Screening and Brief Intervention - National Institute on Alcohol Abuse and Alcoholism, 2005
Alcohol-use Disorders - Diagnosis and Clinical Management of Alcohol-related Physical Complications - AHRQ, NICE, June 2010
Alcohol Alert from the NIAAA: Publications - National Institute on Alcohol Abuse and Alcoholism, 2005
Helping Patients Who Drink Too Much: A Clinician’s Guide - National Institute on Alcohol Abuse and Alcoholism, 2005, updated in 2007
Oregon Healthy Teens Survey - Questionnaire (8th & 11th grade versions) about alcohol, drug and nicotine use.
Behavioral Health and Chemical Dependency
2016 APA Practice Guidelines for the Psychiatric Evaluation of Adults, 3rd edition
AACAP Practice Parameters, American Academy of Child and Adolescent Psychiatry (AACAP), 2015
APA Practice Guidelines for the Pharmacological Treatment of Patients with Alcohol Use Disorder, 2018
APA Practice Guideline on Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia, 2016
2010 APA Practice Guidelines for the Treatment of Patients with Substance Use Disorders; Second Edition
The American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders, (Second Edition – Revised): (ASAM PPC-2R), 2001
Quit for Life: Tobacco use in Adults
Depression Screening and References
Screening for Depression in Adults - AHRQ, Agency for Healthcare Research and Quality, April 2013
Patient Health Questionnaire (PHQ9) Overview
Guidelines for Adolescent Depression in Primary Care (GLAD-PC) Toolkit - Version 2, 2010, The Research Institute
Beck Depression Inventory, Beck, A.T, 1979
Trauma Informed Care
National Child Traumatic Stress Network Empirically Supported Treatments and Promising Practices
Trauma Specific Services: A Resource for Implementation and Use
Trauma-Informed and Trauma-Specific Services
Oral Health
The American Academy of Pediatric Dentistry Policies and Clinical Guideline
The American Dental Association Center for Evidence-Based Dentistry Clinical Practice Guidelines