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

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.

REVISED: C-Reactive Protein and Erythrocyte Sedimentation Rate

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

REVISED: Testosterone Testing Protocol

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 (2018) 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.


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.