Practice Guidelines
Quick links: Medical Guidelines, Behavioral Health Guidelines
Guideline Adoption and Recommended Use
PacificSource adopts medical and behavioral health guidelines to assist providers and members in making decisions about appropriate healthcare. Derived from nationally recognized sources, these guidelines are based on recent medical evidence and/or consensus among physicians regarding clinical treatment patterns. They are not intended to be a substitute for professional medical advice.
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
2017 GINA Report, Global Strategy for Asthma Management and Prevention - Global Initiative for Asthma, 2017
2007 Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma - National Heart Lung and Blood Institute, 2007
Coronary Artery Disease
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults - American Heart Association, 2013
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)
Standards of Medical Care in Diabetes, American Diabetes Association, 2017
Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan 2015 - American Association of Clinical Endocrinologist and American College of Endocrinology, 2015
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
Recommended Child & Adolescent Immunization Schedules Ages 0 to 6 - CDC, 2013
Recommended Child & Adolescent Immunization Schedules Ages 7 to 18 - CDC, 2013
Catch up Immunization Schedule - CDC, 2013
Recommended Adult Immunization Schedule - CDC, 2013
Selected Preventive Screening Recommendations - CDC, 2010
Preventive Guidelines for Children and Adolescents - AHRQ, ICSI, September 2012
Preventive Guidelines for Adults - AHRQ, ICSI, September 2012
Obesity - Adult
Management of Overweight and Obesity in the Adult - AHRQ, Michigan Quality Improvement Consortium, March 2011
Prenatal Care - Routine
Routine Prenatal Care (PDF) - ICSI, July 2012, Fifteenth Edition
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 - PacificSource covers the use of this screening tool. Please use CPT code 99408.
Alcohol Use Disorders Identification Test (AUDIT) - Self-Report Form
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.
Michigan Alcoholism Screening Test (MAST), the quest for a new diagnostic instrument, Selzer, M.L American Journal of Psychiatry, (1971).
Behavioral Health and Chemical Dependency
Psychiatric Evaluation of Adults - American Psychiatric Association, June 2006
AACAP Practice Parameters, American Academy of Child and Adolescent Psychiatry (AACAP), 2015
Practice Guidelines for the Treatment of Patients with Substance Use Disorders; Second Edition - American Psychiatric Association, 2010
The American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders, (Second Edition – Revised): (ASAM PPC-2R), 2001
Depression Screening and References
Screening for Depression in Adults - AHRQ, Agency for Healthcare Research and Quality, April 2013
American Psychiatric Association Practice Guidelines for Treatment of Patients with Major Depressive Disorder, Practice Guideline, May 2006
Patient Health Questionnaire (PHQ9) Overview
Guidelines for Adolescent Depression in Primary Care (GLAD-PC) I. - Identification, Assessment, and Initial Management –American Academy of Pediatrics, 2013
Beck Depression Inventory, Beck, A.T, 1979