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

2016 GINA Report, Global Strategy for Asthma Management and Prevention - Global Initiative for Asthma, 2016

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 

Stable Coronary Artery Disease - Institute for Clinical Systems Improvement, updated May 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, 2016 - Adult (Type I & II and Gestational), Child and Adolescent, American Diabetes Association, January 2016

AACE/ACE Comprehensive Diabetes Management Algorithm 2015 - American Association of Clinical Endocrinologists and American College of Endocrinology, 2015

Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan 2015 - American Association of Clinical Endocrinologist, 2015

Heart Failure

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 Practice Guidelines, June 2013 

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

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Last updated 11/29/2016