BC Guidelines

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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

For information on COVID-19, visit the BC Centre for Disease Control website.

These guidelines summarize suggested wait times for common indications where MRI or CT are the recommended first imaging tests. The purpose is to inform primary care practitioners of how referrals are prioritized by radiologists, radiology departments and community imaging clinics across the province.

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.

This guideline provides recommendations on the primary prevention of atherosclerotic cardiovascular disease (CVD) in adults aged ≥ 19 years without clinical CVD. It does not apply to patients with a known history of CVD or who currently have signs or symptoms of CVD, as this would require treatment and secondary prevention. The recommendations include how to assess a patient’s risk of CVD and how to manage their CVD risk factors.

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.

This new guideline addresses the identification and care management as needed of older adults aged ≥ 65 years living in the community with risk factors for falls. The guideline facilitates individualized assessment and provides a framework and tools to manage risk factors for falls and prevent fall-related injuries.

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.

 

NEW: Appropriate Imaging for Common Situations in Primary and Emergency Care

Appropriate Imaging for Common Situations in Primary and Emergency Care (2019) is a new guideline that provides recommendations to primary and emergency care providers on how to assess the need for diagnostic imaging in five common situations: low-back pain (adults), minor head injuries (all ages), uncomplicated headache (adults), hip and knee pain (adults), and suspected pulmonary embolism (non-pregnant adults). Management of these conditions is beyond the scope of this guideline. However, in some cases, notes and alternatives to imaging are provided for additional clinical context.  

Key recommendations include:

  • Imaging is not recommended for uncomplicated headache unless red flags are present.
  • CT head scans are not recommended in adults and children who have suffered minor head injuries unless positive for a head injury clinical decision rule.
  • Chest CT for suspected pulmonary embolism is not recommended in low-risk patients with a normal D-dimer result.
  • Imaging is not recommended for low back pain unless red flags are present.
  • MRIs of hip or knee joints are not recommended in patients with co-existent pain and moderate to severe osteoarthritis unless red flags are present.
  • Practitioners are encouraged to consult a radiologist if they have any concerns or questions regarding which imaging test is appropriate for a given problem.
 

REVISED: Chronic Kidney Disease - Identification, Evaluation and Management of Adult Patients

Chronic Kidney Disease (2019) provides recommendations for the investigation, evaluation, and management of adults at risk of or with known chronic kidney disease (CKD).

Key recommendations include:

  • Identify high-risk patient groups for evaluation of CKD: diabetes, hypertension, cardiovascular disease, family history, high risk ethnicity (Indigenous peoples, Pacific Islanders, African, Asian, and South Asian descent), history of acute kidney injury (AKI)
  • Screen high-risk patients using eGFR and uACR. Confirm abnormal test results with a repeat measurement and obtain urinalysis
  • Determine likely cause of kidney disease where possible. The cause of CKD has important implications for the risk of end stage renal disease (ESRD) and other complications
  • The three dimensions of Cause, eGFR and Albuminuria (CGA) are all important in developing a management plan
  • Prompt advice from local internists, local nephrologists or the RACE Line is available to assist in determining the need for and timing of referral

Vitamin D Testing (2019) is a revision of our previous Vitamin D Testing Protocol (2013). It has been updated in collaboration with BC’s Agency for Pathology and Laboratory Medicine.

Key Recommendations include:

  • Routine vitamin D testing or screening for vitamin D deficiency is not recommended.
  • Measurement of vitamin D levels is not generally required prior to or after initiating vitamin D supplementation. 
  • Vitamin D testing is indicated in patients who are at high risk for vitamin D deficiency such as those with malabsorption syndromes, renal failure, unexplained bone pain, unusual fractures, or other evidence of metabolic bone disorders.

Updates in the revised version include discussion on the optimal concentration of vitamin D levels, dietary and supplemental information on vitamin D and a brief discussion on the controversies of vitamin D and chronic illness.

The Iron Deficiency – Diagnosis and Management guideline has been updated in collaboration with BC’s Agency for Pathology and Laboratory Medicine. The guideline scope includes diagnosis, investigation and management of iron deficiency in patients of all ages. It features a new algorithm for investigation of non-anemic iron deficiency in adults, a new appendix on pediatric iron doses and liquid formulations, updated medication tables, enhanced information on nutrition including vegetarian and vegan diets, and enhanced information on pediatrics.

New key recommendations include:

  • Use a case-finding approach to identify individuals at risk of iron deficiency and iron deficiency anemia. There is no indication for population-based general screening.
  • Determine the cause of iron deficiency. Consider age and clinical presentation when investigating for cause.
  • Iron deficiency by itself causes symptoms for patients, even in the absence of anemia, and warrants investigation and treatment.
  • Ferritin is the test of choice for the diagnosis of iron deficiency.
  • Ferritin values occur on a continuum. The suggested cut-offs are estimated ranges that should be interpreted using clinical judgment based on the patient’s age, gender, risk profile and symptoms.
  • Serum iron, iron binding capacity, and transferrin saturation/fraction saturation are not routinely useful for investigating iron deficiency anemia.
  • Take a nutrition history and provide dietary education to address dietary risk factors.
  • Caregivers of infants and toddlers should receive guidance to prevent excessive cow’s milk intake.
  • Prescribe oral iron supplements as first line therapy for iron deficiency. One preparation is not preferred over another; patient tolerance should be the guide. Anemia should correct in 2-4 months. Continue oral iron for 4-6 months after anemia corrects to replenish iron stores.
  • Consider prescribing IV iron when there is inadequate response to oral iron, intolerance to oral iron therapy, or ongoing blood loss.

 

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, a Family Physician and experienced computer programmer, 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.