BC Guidelines

Logo of 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

New Prostate Cancer Guideline - Open for External Review until June 30th, 2019

The draft Prostate Cancer: Diagnosis, Referral and Follow-up in Primary Care, a new BC Guideline developed in collaboration with BC Cancer’s Provincial Primary Care Program Family Practice Oncology Network, provides recommendations for primary care providers to guide the investigation and management of adult male patients (≥19 years of age) who present with signs or symptoms that could lead to a diagnosis of prostate cancer.

Peer review is a critical component of guideline development. Please visit our External Review page  to download the draft guideline and submit your feedback via our new online questionnaire. 

C-Reactive Protein and Erythrocyte Sedimentation Rate

C-Reactive Protein and Erythrocyte Sedimentation Rate Testing (2018)

– A revision of our previous ESR guideline, the guideline scope has expanded to include recommendations for the use of CRP and ESR as investigative tests in adults in primary care.

Select Key Recommendations include (see full recommendation list):

  • CRP is the preferred first test to support a diagnosis of inflammatory or infectious conditions, rather than ESR. There is no indication for ordering ESR when CRP is elevated.
  • According to the British Columbia Laboratory Services Outpatient Payment Schedule, ESR will be performed only if a written indication is provided on the requisition. If CRP and ESR are ordered together, most outpatient laboratories will only perform CRP because only CRP is payable.
  • Clinical features that together may prompt a requisition for CRP are:
    1. unexplained symptoms or a deterioration of health status; and
    2. an inflammatory or infectious disease is suspected; and
    3. a specific diagnosis is not made effectively by other means.

Testosterone Testing Protocol

Testosterone Testing Protocol (2018)

The Testosterone Testing Protocol (2018) summarizes the appropriate use of serum testosterone testing in men and women aged ≥19 years. It is an updated version of the 2011 Testosterone Testing Protocol. Key changes include: recommendations that patients fast, use the same lab for initial and follow-up tests, and be tested when the sleep-wake cycle is stable. The protocol has also been updated to include age-dependent approximate lower limits of normal for men, and a new Hypogonadism Investigation Algorithm (PDF, 117KB).  The protocol was developed in collaboration with BC’s Agency for Pathology and Laboratory Medicine. The protocol working group included representatives of family medicine, endocrinology, laboratory medicine, and pharmacy.

Key recommendations include:

  • Testing for testosterone deficiency is not recommended in asymptomatic men or women.
  • The decision to test must be guided by medical history and clinical examination.
  • Testosterone deficiency in men usually presents with a constellation of symptoms. Erectile dysfunction in isolation is not an indication for testosterone testing.
  • In men, serum total testosterone must be collected in the morning, preferably before 10AM, or within 3 hours of waking, and preferably in a fasting state.
  • Men receiving stable androgen replacement can be tested annually.
  • Testosterone testing is not useful for the investigation of low libido in women.


Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder

Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder (2018)

This BC guideline is a revision of the 2010 version of the guideline. The guideline scope has expanded to include pediatric and pregnant patients and a laboratory algorithm has also been added to the guideline.

Key changes to note include:

  1. The laboratory algorithm outlines changes to ordering. If central hypothyroidism is being investigated "suspicion of pituitary insufficiency" should be included as a clinical indication and a request for fT4 (with or without TSH) should be indicated in the space provided on the standard out-patient laboratory requisition.
  2. Thyroid function test reports will include additional information. Laboratories in BC will be reporting trimester specific reference intervals as an appended comment on all women of child bearing age.

Opioid Use Disorder - Diagnosis and Management in Primary Care 

Opioid Use Disorder - Diagnosis and Management in Primary Care (2018)

This new BC Guideline, developed in collaboration with the BC Centre on Substance Use, presents recommendations for diagnosis and management of opioid use disorder in primary care.  The guideline focuses 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.

Ultrasound Prioritization

Ultrasound Prioritization (2018)

This new BC Guideline summarizes suggested wait times for common indications where ultrasound is the recommended first imaging test. The purpose is to inform primary care practitioners of how referrals are prioritized by radiologists, radiology departments and community imaging clinics across the province.  In some cases, notes and alternative tests are provided for additional clinical context.  This guideline is an adaptation of the British Columbia Radiological Society (BCRS) Ultrasound Prioritization Guidelines (2016).

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.