BC Guidelines


 

BC Guidelines are clinical practice guidelines and protocols that provide recommendations to B.C. practitioners on delivering high quality, appropriate care to patients with specific clinical conditions or diseases. These “Made in BC” clinical practice guidelines are developed by the Guidelines and Protocol Advisory Committee (GPAC), an advisory committee to the Medical Services Commission. The primary audience for BC Guidelines is BC physicians, nurse practitioners, and medical students. However, other audiences such as health educators, health authorities, allied health organizations, pharmacists, and nurses may also find them to be a useful resource.

There are several ways to find the guidelines you are looking for.

What's New

Open for External Review - Draft Opioid Use Disorder - Diagnosis and Management in Primary Care - developed in collaboration with the BC Centre on Substance Use

Open until December 18th, 2017

This guideline presents recommendations for diagnosis and management of opioid use disorder in primary care with a focus on induction and maintenance of buprenorphine/naloxone (Suboxone®) opioid agonist treatment for adults and youth (ages 12 years and older).   

This is a summary version of the recently published provincial Guideline for the Clinical Management of Opioid Use Disorder developed by the BC Centre on Substance Use and Ministry of Health, available at bccsu.ca.

Please visit our External Review page to download the draft guideline and submit your feedback via our new online questionnaire.

Frailty in Older Adults - Early Diagnosis and Management

We are pleased to announce the release of the revised guideline Frailty in Older Adults - Early Identification and Management (2017).

Key recommendations include:

  • Early identification and management of patients with frailty or vulnerable to frailty provides an opportunity to suggest appropriate preventive and rehabilitative actions (e.g. exercise program, review of diet and nutrition, medication review) to be taken to slow, prevent, or even reverse decline associated with frailty.
  • Use a diligent case finding approach to identify patients with frailty, particularly among older adults who regularly or increasingly require health and social services. However, routine frailty screening of the general population of older adults is not recommended.
  • Many patients with frailty can be assessed and managed in the primary care setting through a network of support, which may include family, caregivers, and community care providers. Coordinate care with other care providers and ensure patients and caregivers are referred to or connected with local health care and social services.
  • Polypharmacy is common in patients with frailty. Consider the benefits and harms of medications by conducting a medication review in all patients with frailty.
  • Initiate advance care planning discussions for patients with frailty or vulnerable to frailty.

We are also pleased to introduce a number of resources to accompany this guideline:

New BC Guidelines Mobile App Now Available at BCGuidelinesApp.ca

We are pleased to announce the release of our new BC Guidelines Mobile App for Android and Apple devices.

BC Guidelines has partnered with Dr. Matthew Toom, an experienced computer programmer and UBC Family Medicine Resident, to create the new BC Guidelines Mobile App. The free and redesigned mobile app works even without Internet connectivity so busy practitioners can instantly access BC Guidelines on any Apple or Android mobile device no matter where they are working.

Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management (2017)

REVISION - August 2017: The COPD Flare-Up Action Plan has been updated to clarify how long a patient should wait before commencing an oral corticosteroid or antibiotic during a COPD flare-up - see COPD Flare-Up Action Plan.  

We are pleased to announce the release of the revised guideline Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management (2017).

New and amended key recommendations include:

  • Use spirometry to confirm airflow obstruction in all patients suspected of having COPD. [Amended, 2017]
  • Implement pharmacologic therapy in a stepwise approach and use the lowest step that achieves optimal control based on the patient’s severity of COPD. [New, 2017]
  • Develop an exacerbation action plan with the patient for pharmacologic therapies including short-acting bronchodilators, oral corticosteroids, and antibiotics. [Amended, 2017]
  • Use routine follow-ups to evaluate the patient's inhaler technique and adherence regularly. Evaluating inhaler technique is particularly important in patients who are older, frail, or cognitively impaired. [New, 2017]

The Flare-Up Action Plan, Patient Care Flow Sheet and the Resource Guide for Patients have also undergone significant revisions.

Palliative Care for the Patient with Incurable Cancer or Advanced Disease: Part 1-3 (2017)

In collaboration with the Family Practice Oncology Network, we are also pleased to launch the revised version of the guideline Palliative Care for the Patient with Incurable Cancer or Advanced Disease: Parts 1-3.

  • Part 1: Approach to Care (2017): Key recommendations include:
    • Identify patients who would benefit from palliative care early in the illness trajectory: a palliative approach addresses the need for pain and symptom management, as well as psychosocial and spiritual support of patients and their families, beginning in disease management through to survivorship or End-of-Life care.
    • Encourage patients to have an advance care planning discussion with family and/or caregivers.
    • Organize care coordination around key illness transitions.
       
  • Part 2: Pain and Symptom Management (2017): Provides algorithms and strategies for the assessment and management of cancer pain and symptoms associated with advanced disease in patients, including constipation, depression, delirium, dyspnea, fatigue and weakness, nausea and vomiting, and pain management. All medication tables have been updated.
     
  • Part 3: Grief and Bereavement (2017): Key recommendations include:
    • Everyone grieves losses, but it is important to recognize especially vulnerable groups such as the elderly, children, the socially isolated, the mentally ill, the disenfranchised, and culturally diverse groups such as new immigrants and the indigenous community.
    • Distinguish grief from depression and treat grief-related major depression once you are confident it is pathological.
    • In the case of Prolonged Grief Disorder (complicated grief), assess and take note of any risk factors or concerns.

New Partner Guidelines

Biopsychosocialspiritual Withdrawal Management Services and Bugs and Drugs®

We are pleased to provide links to two new partner guidelines on our Partner Guidelines page:

Provincial Guidelines for Biopsychosocialspiritual Withdrawal Management Services - BC Ministry of Health

Adult: http://www.health.gov.bc.ca/library/publications/year/2017/adult-withdrawal-management-services-guidelines-final.pdf 

Youth: http://www.health.gov.bc.ca/library/publications/year/2017/youth-withdrawal-management-guidelines-final.pdf

Bugs and Drugs® - Alberta Health Services

With the support of Alberta Health Services, Alberta Health, the BC Ministry of Health, and the Do Bugs Need Drugs?® program.

 http://www.bugsanddrugs.org
Please note, the link will only work if IP address is from BC or AB.

A Guideline for the Clinical Management of Opioid Use Disorder

The British Columbia Centre on Substance Use and the Ministry of Health have released A Guideline for the Clinical Management of Opioid Use Disorder. The guideline provides evidence-based recommendations to BC physicians and nurse practitioners for the clinical management of opioid use disorder.

Highlights include:

  • Recommending buprenorphine/naloxone as the preferred first-line option for treatment of opioid use disorder; and
  • Strongly recommending against offering withdrawal management (also known as 'detox') as a stand-alone treatment, unless a plan is in place to transition individuals to continued addiction treatment following completion of withdrawal management. 

Until June 5, 2017, this guideline is provided for educational purposes. For clinicians wishing to prescribe buprenorphine/naloxone and/or methadone please refer to the College of Physicians and Surgeons of BC’s Methadone and Buprenorphine: Clinical Practice Guideline for Opioid Use Disorder. After June 5, 2017, this guideline will become the guideline for the province of British Columbia.

For more information on the BC Centre on Substance Use, check out the website at: www.bccsu.ca

Other Updates

Updated GPAC Handbook Now Available

Want to learn more about the Guidelines and Protocols Advisory Committee and the BC Guidelines development process? Check out our recently updated GPAC Handbook (2017)

Introducing the New Online External Review Page

BC Guidelines is pleased to introduce a new External Review of Guidelines page to our website. This new page allows peer reviewers to download draft guidelines and submit questionnaire feedback directly from our website. We are also happy to provide a new online questionnaire that can be submitted through your web browser. Participating as an external reviewer has never been easier!

Earn Continuing Medical Education Credits with BC Guidelines

Update on Mainpro+® Credits for Family Physicians

With the launch of the College of Family Physicians of Canada's new Mainpro+ system, there are now more opportunities to earn credit for continuing medical education / continuing professional development through using and participating in the development of BC Guidelines. For more details, see Continuing Professional Development (CPD) Credits.