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Clinical policies


Practice guideline adoption and recommended use


PacificSource Community Solutions, PacificSource Medicare, and PacificSource Health Plans support the use of practice guidelines based on nationally recognized, valid, and reliable evidence-based clinical literature or a consensus of professionals in a particular field.

PacificSource adopts medical, behavioral, and oral 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.

Asthma

GINA Report, Global Strategy for Asthma Management and Prevention (Global Initiative for Asthma)


COPD

Gold Reports for COPD Management (Global Initiative for Chronic Obstructive Lung Disease)


Diabetes

Standards of Medical Care in Diabetes (American Diabetes Association).

American Association of Clinical Endocrinologists Practice Guidelines (AACE)


Coronary Artery Disease

ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

AACE/ACE Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease

American College of Cardiology (ACC) Guidelines and Clinical Documents


Heart Failure

Guidelines for the Management of Heart Failure (American College of Cardiology, American Heart Association Task Force, and the Heart Failure Society of America on Clinical Practice Guidelines)

American College of Cardiology (ACC) Guidelines and Clinical Documents


Prenatal

American College of Obstetricians and Gynecologists Clinical Information (ACOG)

Breastfeeding Centers for Disease Control and Prevention (CDC) Guidelines


Obesity

Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults 

American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity  (pdf)

American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society (AHA/ACC/TOS) Guideline for the Management of Overweight and Obesity in Adults


Pain

Centers for Disease Control and Prevention (CDC) Opioid Prescribing Guideline Resources for Prescribing Opioid for Chronic Pain

Oregon Pain Guidance (OPG) Pain Treatment Guidelines


Immunizations and Preventive Services

CDC Catch-Up Immunization Schedule Who Start Late or Who Are More Than 1 Month Behind. Recommendations for ages 18 years or younger

CDC Adult Immunization Schedule. Recommendations for ages 19 years or older

CDC Vaccines for Children: Vaccines by Age

U.S. Preventive Services Task Force (USPSTF): Recommendations for primary care and prevention

 

Attention-deficit / hyperactivity disorder (ADHD) Children and Adolescents

Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention Deficit/Hyperactivity disorder in Children and Adolescents, American Academy of Pediatrics


Attention-deficit / hyperactivity disorder (ADHD) Adults

Attention deficit hyperactivity disorder: diagnosis and management, NICE guideline [NG87], National Institute for Health and Care Excellence


Anxiety

Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults, American Family Physician


Autism

Behavior Analyst Certification Board Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guideline for Healthcare Funders and Managers, Second Edition, 2014 


Depression

American Psychiatric Association (APA) Practice Guideline for the Treatment Of Patients With Major Depressive Disorder (PDF)

Journal of Clinical Psychiatry Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression  


Eating Disorders

APA Practice Guideline for the Treatment of Patients with Eating Disorders (pdf) 


Gender-Affirming Care

Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, The World Professional Association for Transgender Health (pdf)


Bipolar Disorder

Bipolar disorder: assessment and management, Clinical guideline [CG185], National Institute for Health and Care Excellence.


Psychotic Disorders

Practice Guideline for the Treatment of Patients with Schizophrenia, American Psychiatric Association

Practice Guidelines for Oregon Early Assessment and Support Alliance (pdf)

Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents, SAMHSA (pdf)


Trauma-Informed Care

Trauma Specific Services: A resource for implementation and use, Trauma Informed Oregon (pdf)


Substance Use Disorders

The American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders

National Institute on Drug Abuse Principles of Drug Treatment: A Research-Based Guide

SAMHSA TIP (Treatment Improvement Protocols) 63: Medications for Opioid Use Disorder For Healthcare and Addiction Professionals, Policymakers, Patients, and Family: Executive Summary (pdf), Full Document (pdf)

SAMHSA Medication for the Treatment of Alcohol Use Disorder: A Brief Guide (pdf)