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BCGuidelines.ca - By BC Physicians, for BC Physicians

Frequently-Asked Questions

See the GPAC Guidelines Handbook for more detailed information www.bcguidelines.ca/pdf/2012-gpac-handbook.pdf

What is BCGuidelines.ca?

How are BCGuidelines.ca’s clinical practice guidelines different from other guidelines?

What are the major features within a BC guideline?

How often is the content updated?

How are the guidelines or protocols subjects chosen?

Who develops the guidelines or protocols?

Who participates on guideline working groups?

Why doesn’t BCGuidelines.ca list the members of each working group?

What criteria must a subject meet before a guideline is developed?

What criteria must the guidelines meet to be published?

How long does it take to develop a guideline?

How does BCGuidelines.ca combat bias in its guidelines?

Why don’t BC guidelines list levels of evidence?

What is the difference between a guideline and a protocol?

Can I access BC Guidelines from my Smartphone?

How do you get a hard copy of a guideline or a binder with the complete guideline library?

Are there Continuing Medical Education (CME) credits available?

Will BCGuidelines.ca answer requests for medical or clinical advice?

Will BCGuidelines.ca answer questions about medical services or treatments available in BC?

Will BCGuidelines.ca answer questions about MSP coverage or the cost of treatments for a particular condition?

How do I correctly reference a BC guideline within my own publication?

Who do I contact if I have additional questions about BCGuidelines.ca?

What is BCGuidelines.ca?

BCGuidelines.ca is the website and main source of clinical practice guidelines and protocols for primary care physicians and other healthcare professionals in British Columbia (BC). BC guidelines are published on this site in HTML and pdf formats.

The intent of these guidelines is to provide practical and easy-to-follow advice to general practitioners, nurse practitioners, and specialists for effective patient care.

How are BCGuidelines.ca's clinical practice guidelines different from other guidelines?

The guidelines are based on systematic reviews of medical evidence and the consensus opinions of BC physicians and other health professionals that serve on the guideline working groups. Recommendations are modified for circumstances in BC. Circumstances can include: rural or remote medicine, ethnicity of the population, or availability of a test or treatment within this jurisdiction. BC Guidelines are used as reference in the construction of billing/payment rules within BC.

The development of the guidelines is done with the oversight of the Guidelines and Protocols Advisory Committee (GPAC). As an advisory committee of the Medical Services Commission (MSC), GPAC is required to develop guidelines that advise practice where there is a large variation in practice within BC, or where changes in practice will afford savings/efficiencies to the Medical Services Plan while improving care to British Columbians.

What are the major features within a BC guideline?

The major features of a BC guideline are:

  • BASICS: including the effective date, introduction, scope, epidemiology (BC specific data), risk factors, prevention, and etiology.
  • DIAGNOSIS: including screening or testing, investigations or tests, assessment, evaluation, differential diagnoses, signs and symptoms, history, physical examination, and staging.
  • MANAGEMENT: care objectives, treatment, lifestyle / patient self-management, indications for referral, co-morbid conditions, complications, poor or incomplete response.
  • ONGOING CARE: Ongoing management, prevention of complications and co-morbidities, follow-up testing, monitoring, prognosis, rehabilitation, recurrence, palliative care, interdisciplinary care, special circumstances.
  • CONTROVERSIES IN CARE: areas of controversy in how to treat, effectiveness of a test or treatment, incomplete evidence, or highly topical in the popular press.
  • RESOURCES: references, Internet resources, diagnostic code, appendices, sponsors, patient guide, medication tables.

Other user-friendly features include:

  • Summaries of many guidelines
  • HTML or PDF versions of the guidelines
  • accessibility through PC or most handheld devices

How often is the content updated?

Each guideline or protocol is reviewed three to four years after its approval date. This review includes examining current evidence for changes in practice and an appraisal of BC Ministry of Health outcome, utilization and impact data. If the desired practice change or evaluation measures are not met then changes to the guideline may be warranted.

How are the guidelines or protocols subjects chosen?

Topics for guidelines or protocols are brought forward by physicians in the community, members of the British Columbia Medical Association (BCMA), UBC Medical School, BC Association of Laboratory Physicians, Pharmaceutical Services Division (Ministry of Health), Laboratory Diagnostic and Blood Services Branch (Ministry of Health), and other groups. Proposed topics, with supporting data, are presented to GPAC for approval. Topics that are accepted move forward to development.

Who develops the guidelines or protocols?

GPAC includes representatives from the BCMA and the Medical Services Branch (MSB) of the Ministry of Health as well as pharmacists, practicing specialists and general practitioners.

GPAC is chaired by one BCMA co-chair selected by the BCMA board of directors, and one MoH co-chair typically the executive director of MSB. Under the direction of the co-chairs, GPAC members choose topics for future guideline development, approve draft guidelines for external review, and approve final draft guidelines for submission to the BCMA board of directors and then to the Medical Services Commission (MSC). GPAC also coordinates strategies to promote and increase the uptake of guidelines and to evaluate patient and health care system outcomes.

Once a topic has been approved for development by GPAC, a working group is formed and, with the support of project leads from the MSB, a draft is developed. The draft is brought to a meeting of GPAC by the working group chair to receive approval to send the guideline out to a random sample of physicians and allied health professionals for external review. Once the review is complete and comments are addressed, the draft is then sent back to GPAC for final approval. After this final approval the guideline is reviewed and finalized by the board of the BMCA and the MSC.

GPAC has also established a process for the joint development of guidelines with partner organizations, such as the Heart and Stroke Foundation, and the Family Practice Oncology Network. Partner organizations use these templates and follow the guideline development process contained in the BC Guidelines handbook.

Who participates on guideline working groups?

Each working group consists of a chair, general practitioners, a cross-section of relevant specialists, and a Ministry of Heath project lead. If necessary, a pharmacist from the Pharmaceutical Services Division of the Ministry of Heath is included in the working group. The working group chair is typically a physician member of GPAC and is responsible for facilitating discussion and decision-making.

Working group members are BC practicing physicians nominated by the BCMA and Ministry of Health. They are chosen for their expertise in the subject area, scope of practice and clinical relevance. Family physicians are well represented to provide insights into making the guidelines practical and usable.

The project lead for each guideline working group organizes and facilitates working group meetings, conducts systematic reviews of the literature, analyzes health care data, and contributes to the drafting of guidelines. Ministry of Health medical consultants, physician advisors to the MSB, also play a key role in guiding development of the guideline and provide critical direction to research staff.

Why doesn't BCGuidelines.ca list the members of each working group?

The names and qualifications of the members of the working groups can be requested by contacting the BCMA. www.bcma.org

What criteria must a subject meet before a guideline is developed?

The following criteria are considered by GPAC for guideline or protocol development:

  • Areas of clinical uncertainty as evidenced by wide variation in practice or outcomes;
  • Conditions where there is good evidence for effective treatment and where mortality or morbidity can be reduced;
  • Procedures and tests that have a high per unit cost and high volume;
  • Priority areas for the achievement of specific health care goals in BC; and
  • Input from physicians and stakeholders based on compelling evidence.

What criteria must the guidelines meet to be published?

See the GPAC handbook www.bcguidelines.ca/pdf/2012-gpac-handbook.pdf for full description of the process of developing BC guidelines, including the approval process prior to online publication.

How long does it take to prepare a guideline?

A guideline or protocol takes from six months to two years to develop depending on the complexity of the subject, the availability of working group members and the schedule of GPAC and Medical Services Commission meetings for approvals.

How does BCGuidelines.ca combat bias in its guidelines?

Any person participating as a member of a GPAC working group is required to complete a conflict of interest declaration. A conflict of interest refers to situations in which personal, occupational or financial considerations may influence a member’s decisions or affect the objectivity or fairness of a member of a GPAC working group. A conflict of interest may be real, potential or perceived in nature.

A real conflict of interest arises where a member of a GPAC working group, or an immediate family member, has an existing private, personal or financial interest in a company or organization whose products or services may be recommended in the clinical practice guideline which the working group is developing.

A potential conflict of interest arises when a member of a GPAC working group foresees that he/she, or an immediate family member, may have a private, personal or financial interest, such as an identified future commitment, in a company or organization whose products or services may be recommended in the clinical practice guideline which the working group is developing.

A perceived (or apparent) conflict of interest may exist when a reasonably well-informed person has a reasonable belief that a member of a GPAC working group participates in decisions that promote the member’s private, personal or financial interest.

Bias is also addressed by the review process prior to publication. Any conflict that is brought forward during the external review, review by GPAC or the Medical Services Commission is addressed.

Why don't BC guidelines list levels of evidence?

Levels of evidence are not explicitly stated within the GPAC guidelines, the research approach is standardized.  The evidence review process used in the development of BC guidelines is conducted with reference to the Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence www.cebm.net. The CEBM Levels of Evidence document sets out one approach to systematizing the process for different clinical question types. Further information about the evidence used in BC Guidelines can be found in the GPAC Handbook. www.bcguidelines.ca/pdf/2012-gpac-handbook.pdf

What is the difference between a guideline and a protocol?

Guidelines are defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Protocols are a precise outline for the study of a biomedical problem or for a regimen of therapy.

Can I access BC guidelines from my Smartphone?

Yes. BCGuidelines.ca automatically converts to a mobile version when you visit the site using the browser on your Smartphone or other mobile device.

How do you get a hard copy of a guideline or a binder with the complete guideline library?

As of 2009, BC Guidelines no longer provide hard copies of the guidelines or guideline binders. Prior to 2008 complete guideline binders were mailed to all GPs in the province. At BCGuidelines.ca, pdf versions of the guidelines are available to print. On the BCGuidelines.ca home page there is a button for downloading all of the guidelines in one file to print or to reference on the computer.

Are there CME credits available?

CME credits are available for reading and reviewing guidelines. Details can be found at www.bcguidelines.ca/cme_education.html.

Will BCGuidelines.ca answer requests for medical or clinical advice?

No. The BCGuidelines.ca e-mail inbox is not staffed by healthcare professionals. We can only answer questions directly about the development of the guidelines. For specific medical services or clinical advice, please contact your GP or call 811. Online information is provided by www.healthlinkbc.ca.

Will BCGuidelines.ca answer questions about medical services or treatments available in BC?

No. The BCGuidelines.ca e-mail inbox is not staffed by healthcare professionals. For answers to specific questions about medical services or treatments, contact your GP or call 811. Online information is provided by www.healthlinkbc.ca.

Will BCGuidelines.ca answer questions about MSP coverage or the cost of treatments for a particular condition?

No. BCGuidelines.ca cannot answer specific questions about MSP coverage or the treatment of a particular condition.  For questions about MSP and costs of treatment, please contact:

Telephone (Vancouver only) 604 683-7151
Toll-free 1 800 663-7100
Fax 250 405-3595
E-mail mspenquiries@hibc.gov.bc.ca
Mailing Address Medical Services Plan
PO Box 9035 Stn Prov Govt
Victoria, B.C. V8W 9E3
Web sites:
http://www.health.gov.bc.ca/msp/infoben/benefits.html

How do I correctly reference a BC guideline within my own publication?

A reference to a BC guideline should be written in this form:

Medical Services Commission of British Columbia, Guidelines and Protocols Advisory Committee.  insert guideline title. C insert guideline year [updated year month day; cited year month day]. Available from http://www.bcguidelines.ca/.

Who do I contact if I have additional questions about BCGuidelines.ca?

Guidelines and Protocols Advisory Committee
PO Box 9642 STN PROV GOVT
Victoria, BC V8W 9P1
Fax: 250 952-1417
Email: hlth.guidelines@gov.bc.ca


Disclaimer The Clinical Practice Guidelines (the "Guidelines") have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problems.  We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.