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

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

This guideline deals with investigation of blood on dipstick urine testing and proven microscopic hematuria in adults (age 19 and over). Gross hematuria workup is outside of the scope of this guideline.

This protocol revision provides guidance on appropriate testing for suspected urinary tract infection (UTI) in adults ≥ 19 years. It also includes guidance in certain populations with potential asymptomatic bacteriuria, such as the elderly, pregnant women and those who will undergo a urologic procedure. Links to resources for management are provided.

This guideline applies to adult patients with suspected Obstructive Sleep Apnea. A brief section on children is included to support referral and diagnosis. Key updates to the retired guideline include: 1) inclusion and exclusion criteria for a Home Sleep Apnea Test (HSAT), 2) a patient pathway for patients with sleep complaints and 3) a Diagnostic Sleep Medicine Requisition and Referral form.

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.

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

The Prostate Cancer Guidelines Part 1: Diagnosis and Referral in Primary Care and Part 2: Follow-up in Primary Care are new guidelines developed as a collaboration with the BC Cancer Primary Care Program, Family Practice Oncology Network. The scope of Part 1 is to provide recommendations for primary care providers for 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 and well as recommendations for informed discussion of the risks and benefits of PSA testing for asymptomatic men.

The scope of Part 2 is to provide recommendations for the follow-up of patients who have returned to their primary care provider following curative-intent treatment for prostate cancer.

Key Recommendation include:

Part 1: Diagnosis and Referral in Primary Care

  • The decision to use PSA testing for the early detection of prostate cancer should be individualized.
  • Patients should be informed of the potential risks as well as the potential benefits of PSA testing.
  • Not all men diagnosed with prostate cancer require immediate treatment and may undergo a program of active surveillance which significantly reduces many harms associated with radical treatment.
  • PSA testing of men without symptoms or other clinical suspicion of prostate cancer is not an insured benefit in BC under the Medical Services Plan.
  • For men without a diagnosis of prostate cancer and PSA test results within the appropriate age based reference range, further testing in less than 2 years is not indicated.
  • Refer any patients with a hard or irregular prostate to urology regardless of PSA test results.
  • For men taking 5-alpha reductase inhibitors (i.e. finasteride and dutasteride), PSA will drop by approximately 50%. For accurate interpretation relative to lab-reported aged-based ranges, adjust the reported result by a factor of 2.
  • PSA testing should be avoided if the patient has signs or symptoms of acute prostatitis (e.g. dysuria, hematuria, pelvic/groin pain, fever/chills).

Part 2: Follow-up in Primary Care

  • PSA lab reports typically flag a PSA value of greater than the age-based reference range as abnormal, but a biochemical recurrence of the prostate cancer is detected at a much lower PSA value (for example >0.2 μg/μL for a patient after radical prostatectomy).
  • Primary care providers should review the actual values and ensure patients are referred back to the oncologist if any measurable increase in PSA is detected.
  • Consider referral to the Prostate Cancer Supportive Care Program, which is a comprehensive survivorship program for prostate cancer patients, their partners and family from the time of initial diagnosis onwards. Care Program (Family Practice Oncology Network).

Hypertension – Diagnosis and Management (2020) is a revision of our previous guideline (2015) and provides recommendations to primary care practitioners on diagnosing and managing hypertension (HTN) in adults. Management of secondary causes of HTN, accelerated HTN, acute HTN in emergency settings, and HTN in pregnant adults are out of scope.

Key Recommendation include:

  • Hypertension is a modifiable risk factor for cardiovascular disease (CVD) and an important public health issue.
  • When measuring blood pressure in the office, the use of an automated office blood pressure (AOBP) electronic device is recommended in patients with regular heart rate.
  • Hypertension is diagnosed in adults when automated office blood pressure reading is ≥ 135/85 in the higher BP arm.
  • When a manual office blood pressure device (MOBP) is used hypertension is diagnosed at ≥ 140/90.
  • Consider 24-hour ambulatory blood pressure monitoring, or standardized home blood pressure monitoring, to confirm a hypertension diagnosis in all patients.
  • A desired blood pressure level should be determined with each adult patient. Achieving an automated blood pressure reading of ≤ 135/85 is associated with the greatest reduction of risk for adults with no co-morbid conditions.
  • Health behaviour change is recommended as a first step for those with average blood pressure 135-154/85-94 (AOBP), low-risk for cardiovascular disease and no co-morbidities.
  • Initiate pharmaceutical management in context of the patient’s overall cardiovascular risk and not solely on their blood pressure.

The updated guideline includes an algorithm on the diagnosis, detection, and management of hypertension. The algorithm emphasizes the impact of health behaviours, encourages involving the patients and shared decision making, provides a targeted formulary and a follow-up plan. A list of quality indicators are also included in the appendix.

 

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

 

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.

To learn more about BC Guidelines see our video below

BC Guidelines Overview