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

2018 GINA Report, Global Strategy for Asthma Management and Prevention - Global Initiative for Asthma, 2018

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

Care Guidelines for Adults Services Task Force 2017

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