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Clinical Policies


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

2019 Global Initiative for Asthma Management Guidelines. A report based on comprehensive research reviews on the Global Strategy for Asthma Management and Prevention


Coronary Artery Disease

2019 American College of Cardiology Guidelines and Clinical Documents. 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, 2017


COPD

2020 Gold Reports for COPD Management. Evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature.


Diabetes - Adult (Type I & II and Gestational), Child and Adolescent (Type I & II)

2020 Standards of Medical Care in Diabetes. Type 1 and 2 diabetes adult, child and adolescent standards of care from the American Diabetes Association.

2020 American Association of Clinical Endocrinologists Practice Guidelines. 2020 type 2 diabetes management algorithm and comprehensive diabetes care plans from the American Association of Clinical Endocrinologists. 


Heart Failure

Guidelines for the Management of Heart Failure. 2017 report of the American College of Cardiology, American Heart Association Task Force, and the Heart Failure Society of America on Clinical Practice Guidelines


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, 2020

CDC Adult Immunization Schedule, 2020

CDC Vaccines for Your Children: Protect Your Child at Every Age, 2020

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 (pdf)

America Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity. Endocrine Practice. 2016:(aop) (pdf)

Guidelines for the Management of Overweight and Obesity In Adults, 2013


Pain

CDC Guideline for Prescribing Opioids for Chronic Pain, 2018

Oregon Pain Guidance 2020


Prenatal Care - Routine

American College of Obstetricians and Gynecologists (ACOG) Clinical Information, 2020

Breastfeeding CDC Guidelines, 2020


Compendia

NCCN Drugs and Biologics

Micromedex

 

 

ADHD

Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention Deficit/Hyperactivity disorder in Children and Adolescents, American Academy of Pediatrics, 2019 (pdf)


Alcohol Abuse Screenings and References

Alcohol Use Disorders Identification Test (AUDIT) Interview and Self Report Form (pdf)

A Pocket Guide for Alcohol Screening and Brief Intervention for Youth (pdf) - National Institute on Alcohol Abuse and Alcoholism, 2011


Substance Use Disorders

The American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders, Third Edition, 2013

National Institute on Drug Abuse Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), 2018

National Institute on Drug Abuse Resource Guide: Screening for Drug Use in General Medical Settings, 2012 (pdf)

SAMHSA TIP (Treatment Improvement Protocols) 31: Screening And Assessing Adolescents for Substance Use Disorders, 2012


Medication-Assisted Treatment

SAMHSA TIP (Treatment Improvement Protocols) 63: Medications for Opioid Use Disorder Executive Summary, May 2020 (pdf) 

SAMHSA Medication for the Treatment of Alcohol Use Disorder: A Brief Guide, 2015 (pdf)  


Mental Health

2016 APA Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition (pdf)

AACAP Practice Parameters, American Academy of Child and Adolescent Psychiatry (AACAP), 2015

APA Practice Guideline on Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia, 2016 (pdf)

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


Depression Screening and References

Screening for Depression in Adults - AHRQ, Agency for Healthcare Research and Quality, April 2013  

PHQ-9 in Languages other than English (pdf)

Beck Depression Inventory, Beck, A.T, 1979

Journal of Clinical Psychiatry Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression, 2018  


Trauma-Informed Care

National Child Traumatic Stress Network Empirically Supported Treatments and Promising Practices

Trauma Specific Services: A Resource for Implementation and Use 


Autism

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